CMS Price Transparency Data

Ultrasound, pelvis

Facility: Good Samaritan Regional Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $103
Cash Discount Price: $284
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Good Samaritan Regional Medical Center is $103. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $284. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.96x the Medicare baseline. Located in 3600 Nw Samaritan Drive, Corvallis, OR.

Cash / Self-Pay

$284

Average discount available for prompt cash payment at this facility.

Insurance Median

$103

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: $284 (266%)

Insurance Median: $103 (96%)

Cash: $284 (266% of Medicare)

Ins. Median: $103 (96% 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.

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
Pacificsource	$28 - $518	26%
Devoted Health	$31 - $115	29%
Healthnet	$31 - $718	29%
Humana	$31 - $722	29%
Samaritan	$31 - $592	29%
Cigna	$32 - $703	30%
Ihn	$34 - $113	32%
Regence	$35 - $411	33%
Moda	$38 - $333	36%
Providence	$40 - $718	37%
Aetna	$55 - $703	51%
First Choice	$74 - $240	69%

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 $284.
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 Good Samaritan Regional 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.