CMS Price Transparency Data

Ultrasound, pelvis

Facility: Fairfield Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $656
Cash Discount Price: $425
vs. Medicare Baseline: 6.14x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Fairfield Medical Center is $656. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $425. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.14x the Medicare baseline. Located in 401 North Ewing Street, Lancaster, OH.

Cash / Self-Pay

$425

Average discount available for prompt cash payment at this facility.

Insurance Median

$656

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $425 (398%)

Insurance Median: $656 (614%)

Cash: $425 (398% of Medicare)

Ins. Median: $656 (614% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 614% of the Medicare baseline (a markup of 514%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Humana	$91 - $5,966	85%
Aetna	$99 - $5,966	93%
Blue Cross Blue Shield	$99 - $26,250	93%
Buckeye Community Health	$99 - $9,436	93%
Medical Mutual	$99 - $33,500	93%
Medicare (plans)	$99 - $5,966	93%
Medigold	$101 - $6,088	95%
Molina	$101 - $10,045	95%
The Health Plan	$101 - $6,086	95%
UnitedHealthcare	$101 - $6,088	95%
Va Ccn	$101 - $6,088	95%
Valor Health Plan	$101 - $6,086	95%
Caresource	$103 - $7,914	96%
Oscar	$131 - $6,173	123%
Medicaid / KanCare	$139	130%
Bwc	$140 - $8,456	131%
Amerihealth Caritas Ohio	$146	137%
Allied Benefit Systems	$656	614%
Meritain Health	$656	614%
Quality Care Partners/Ohio Ppo Connect	$680	637%
The Ohio State Health Plan	$727	681%
Cigna	$778	728%
Ohio Healthy	$887	830%
Multiplan	$897	840%
Miscellaneous Plans	$944	884%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $425.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 76856.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Fairfield Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 76856.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.