CMS Price Transparency Data

Ultrasound, pelvis

Facility: Lafollette Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76856
  • Insurance Median: $103
  • Cash Discount Price: $361
  • vs. Medicare Baseline: 0.96x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at Lafollette Medical Center is $103. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $361. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.96x the Medicare baseline. Located in 923 East Central Avenue, La Follette, TN.
Cash / Self-Pay
$361

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: $361 (338%)
Insurance Median: $103 (96%)
Cash: $361 (338% 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.

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 $42 - $71 39%
UnitedHealthcare $42 - $1,204 39%
Blue Cross Blue Shield $46 - $253 43%
Bluecare $47 - $53 44%
Aetna $71 - $749 66%
Wellcare $71 66%
Amerigroup $89 83%
Tricare $93 87%
Veterans Eval Services $95 89%
Node Champva $98 92%
Humana $100 - $265 94%
Medicare (plans) $100 94%
Node Bluecare Plus Tn Mcr Adv $100 94%
Triwest $100 94%
Node Devoted Health Mcr Adv $102 95%
Node Farm Bureau Mcr Adv $102 95%
Node Hospice Non Par Agree $102 95%
Node Va $102 95%
Node Wellcare Mcr Adv $102 95%
Node Blueadvantage Mcr Adv $103 96%
Node Healthspring Mcr Adv $103 96%
Node Amerigroup Mcr Adv $105 98%
Windsor Health Plan $105 98%
Node Nhc Mcr Adv $110 103%
Node Us Dept Of Labor $127 119%
Cigna $140 131%
Novanet Work Comp Tn $158 148%
Tn Work Comp $160 150%
Ambetter / Centene $188 176%
Node Point Comfort Underwriters $224 210%
Self Pay $346 324%
Multiplan Complementary $915 857%
Beech Street Work Comp Tn $15,862 14851%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 923 East Central Avenue, La Follette, TN 37766
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals