CMS Price Transparency Data

Ultrasound, pelvis

Facility: Prisma Health Tuomey Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76856
  • Insurance Median: $180
  • Cash Discount Price: $760
  • vs. Medicare Baseline: 1.69x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at Prisma Health Tuomey Hospital is $180. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $760. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.69x the Medicare baseline. Located in 129 N Washington St, Sumter, SC.
Cash / Self-Pay
$760

Average discount available for prompt cash payment at this facility.

Insurance Median
$180

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: $760 (712%)
Insurance Median: $180 (169%)
Cash: $760 (712% of Medicare)
Ins. Median: $180 (169% 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.

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
Medicaid / KanCare $80 - $180 75%
Blue Cross Blue Shield $98 - $576 92%
Cigna $98 - $535 92%
Covid19 Hrsa Uninsured Testing & Treatment Fund [904] $98 92%
Humana $98 - $877 92%
Medicare (plans) $98 - $103 92%
Triwest Healthcare Alliance Vcp [902] $98 92%
Va Community Care Network-Vaccn [903] $98 92%
Tricare $100 94%
UnitedHealthcare $101 - $240 95%
Aetna $103 - $924 96%
Healthy Conn Prime-First Choice Vip Care [5300] $103 96%
Healthy Conn Prime-Molina Healthcare [5330] $103 96%
Healthy Conn Prime-Wellcare Prime By Atc [5310] $103 96%
Bluechoice [810] $127 - $576 119%
Workers Comp [600] $137 128%
Scdc-Sc Dept Of Corrections [7232] $150 140%
Ambetter / Centene $180 169%
Golden Rule Insurance Company [2991] $240 225%
Oxford Health Plans [2992] $240 225%
Zzumr-Salt Lake City Ut [3169] $240 225%
Prisma Health Seniorcare Pace - Midlands [5400] $271 254%
Prisma Health Seniorcare Pace-Upstate [5200] $271 254%
Bob Jones Univ-Pai [821] $311 291%
Promise Health Plan Contracted [2401] $409 - $701 383%
Orangeburg Senior Helping Center Pace [5401] $468 438%
Planned Administrators [820] $576 539%
Meritain Health Contracted [2200] $748 - $924 700%
Preferred Administrators Contracted [2839] $818 766%
Medcost [2940] $865 - $970 810%
Atlantic Packaging Contracted [4833] $877 821%
Aps Healthcare System [2981] $935 875%
Multiplan/Phcs Contracted [2950] $1,040 974%
Vsp Vision Care [2986] $1,052 985%
First Health Contracted [2952] $1,087 1018%
Furman Int/Allen University Student [2951] $1,087 1018%
Quiktrip-First Health [3067] $1,087 1018%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 129 N Washington St, Sumter, SC 29150
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals