CMS Price Transparency Data
Ultrasound, pelvis
Facility: Mount Carmel New Albany Surgical Hospital
Billing Code: 76856 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 76856
- Insurance Median: $228
- Cash Discount Price: $586
- vs. Medicare Baseline: 2.13x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at Mount Carmel New Albany Surgical Hospital is $228. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $586. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.13x the Medicare baseline. Located in 7333 Smith's Mill Road, New Albany, OH.
Cash / Self-Pay
$586
Average discount available for prompt cash payment at this facility.
Insurance Median
$228
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: $586 (549%)
Insurance Median: $228 (213%)
Cash: $586 (549% of Medicare)
Ins. Median: $228 (213% 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 213% of the Medicare baseline (a markup of 113%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicare (plans) | $89 - $106 | 83% |
| Aetna | $99 - $489 | 93% |
| Blue Cross Blue Shield | $99 - $489 | 93% |
| Hospice Mount Carmel | $101 | 95% |
| Oscar | $101 | 95% |
| UnitedHealthcare | $101 - $763 | 95% |
| The Health Plan | $103 - $321 | 96% |
| Enterprise Group Planning | $195 | 183% |
| Custom Design Benefits | $211 | 198% |
| Geha | $220 - $763 | 206% |
| Gravie Admin Services | $220 | 206% |
| Healthez | $220 | 206% |
| Meritain | $220 | 206% |
| Webtpa | $220 | 206% |
| Access Health | $228 | 213% |
| Acclaim | $228 | 213% |
| Administrative Concepts | $228 | 213% |
| Allegeant | $228 | 213% |
| Allied Benefit Systems | $228 | 213% |
| American Family | $228 | 213% |
| American Healthcare Alliance | $228 | 213% |
| American National | $228 | 213% |
| American Republic | $228 | 213% |
| Amerihealth | $228 | 213% |
| Aultcare | $228 | 213% |
| Automated Benefit Services | $228 | 213% |
| Auxiant | $228 | 213% |
| Benefit Administrative Systems,Llc | $228 | 213% |
| Boon Chapman | $228 | 213% |
| Cam Administrative Services | $228 | 213% |
| Christian Brother Services | $228 | 213% |
| Christian Brothers Holy Cross | $228 | 213% |
| Claimchoice Adminstrators | $228 | 213% |
| Comprehensive Benefits | $228 | 213% |
| Continental Life Insurance | $228 | 213% |
| Coventry | $228 | 213% |
| Custom Benefit Administrators | $228 | 213% |
| Cypress Benefit Administrators | $228 | 213% |
| Employee Benefit Concepts | $228 | 213% |
| Employee Benefit Management | $228 | 213% |
| Forest County Potawatomi | $228 | 213% |
| Freedom Life Insurance Company | $228 | 213% |
| Group Administrators | $228 | 213% |
| Group Marketing Services | $228 | 213% |
| Group Pension Administrators | $228 | 213% |
| Guardian | $228 | 213% |
| Health America | $228 | 213% |
| Health Choices | $228 | 213% |
| Healthcare Management Admin | $228 | 213% |
| Insight | $228 | 213% |
| Intercare | $228 | 213% |
| Jfp Benefit Management | $228 | 213% |
| Jp Farley Corporation | $228 | 213% |
| Key Benefit Administrator | $228 | 213% |
| Liberty Union Life Assurance Co | $228 | 213% |
| Lucent Health | $228 | 213% |
| Luminare Health | $228 | 213% |
| Magnacare | $228 | 213% |
| Medcost | $228 | 213% |
| Mutual Health Services | $228 | 213% |
| Mutual Of Omaha | $228 | 213% |
| Ncas | $228 | 213% |
| Nippon Life Ins | $228 | 213% |
| Nova | $228 | 213% |
| Painters Union Insurance Fund | $228 | 213% |
| Physicians Mutual | $228 | 213% |
| Plumbers Local 98 Insurance Fund | $228 | 213% |
| Prairie States | $228 | 213% |
| Preferred One | $228 | 213% |
| Primary Physician Care | $228 | 213% |
| Professional Benefit Administrators | $228 | 213% |
| Quality Care Partners | $228 | 213% |
| Secureone Preferred United Plans | $228 | 213% |
| Siho Insurance Services | $228 | 213% |
| Sisco Benefits | $228 | 213% |
| The Loomis Company | $228 | 213% |
| Trustmark Small Business Benefits | $228 | 213% |
| U Of M Health Plan | $228 | 213% |
| Unicare | $228 | 213% |
| Unified Group Services | $228 | 213% |
| Us Health And Life | $228 | 213% |
| Valenz | $228 | 213% |
| Varipro | $228 | 213% |
| Wps | $228 | 213% |
| Rural Carrier Health Benefit Plan | $230 | 215% |
| Medical Mutual | $248 - $388 | 232% |
| Humana | $250 - $489 | 234% |
| First Health | $258 | 242% |
| Medben | $293 - $367 | 274% |
| Consociate | $299 | 280% |
| Health Ohio Network | $299 | 280% |
| Caresource | $357 | 334% |
| Western & Southern Financial Group | $359 | 336% |
| Healthlink Inc | $367 | 344% |
| Medical Benefits Mutual | $367 | 344% |
| Ohio Health Choice | $367 | 344% |
| Ohio Ppo Connect | $367 | 344% |
| Blue Benefit Administrators Of Massachusetts | $376 | 352% |
| Blue Care Network | $376 | 352% |
| Blue Distinction Transplant | $376 | 352% |
| Blue Shield - Ca | $376 | 352% |
| Blue Shield - Id (Regence) | $376 | 352% |
| Blue Shield - Ny Highmark Northeastern | $376 | 352% |
| Blue Shield - Ny Highmark Western | $376 | 352% |
| Blue Shield - Pa (Highmark) | $376 | 352% |
| Blue Shield - Wa (Regence) | $376 | 352% |
| Ameriben | $391 | 366% |
| Luminare Health (Detroit) | $391 | 366% |
| Medi Share | $391 | 366% |
| Multiplan | $391 | 366% |
| Ohiohealthy | $391 | 366% |
| Osu Not Independent Choice | $391 | 366% |
| Phcs | $391 | 366% |
| Philadelphia American Life Insurance | $391 | 366% |
| Twin Valley Psychiatric | $391 | 366% |
| Health Smart | $416 | 389% |
| Bccp | $489 | 458% |
| Medicaid / KanCare | $489 | 458% |
| Optima Health | $489 | 458% |
| American Postal Workers Secondary | $527 | 493% |
| Cigna | $527 | 493% |
| Health Partners | $527 | 493% |
| Healthgram | $527 | 493% |
| Mvp | $527 | 493% |
| Priority Health | $527 | 493% |
| Crime Victim Assistance | $632 | 592% |
| Ohio Safe Program | $632 | 592% |