CMS Price Transparency Data

Ultrasound, pelvis

Facility: Arthur G James Cancer Hospital and Research Institute

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $320
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.00x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Arthur G James Cancer Hospital and Research Institute is $320. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.00x the Medicare baseline. Located in 460 W 10Th Ave, Columbus, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$320

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%)

Insurance Median: $320 (300%)

Ins. Median: $320 (300% 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 300% of the Medicare baseline (a markup of 200%). 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
Healthspan	$121 - $5,413	113%
Medigold	$121	113%
Upper Ohio Valley	$121 - $5,413	113%
Medicare (plans)	$122 - $5,467	114%
Humana	$123 - $5,521	115%
Medicaid / KanCare	$140 - $192	131%
Aetna	$147 - $5,388	138%
United	$154 - $502	144%
Caresource	$182 - $272	170%
Mmo	$182 - $466	170%
Molina	$182 - $5,388	170%
Odrc	$192 - $224	180%
Blue Cross Blue Shield	$203 - $724	190%
Buckeye Community	$204 - $271	191%
Amerihealth	$205 - $297	192%
Osu Health Plan	$252 - $365	236%
Lifetrac	$359 - $375	336%
Ohio Ppo	$362	339%
Ohiohealth	$397 - $403	372%
Cigna	$400 - $580	374%
Frontpath	$442	414%
Healthsmart	$497	465%
Multiplan	$513	480%
Ohio Dept Of Health	$4,289	4016%

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 $X.
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 Arthur G James Cancer Hospital and Research Institute 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.