CMS Price Transparency Data

Ultrasound, pelvis

Facility: Tristar Horizon Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $401
Cash Discount Price: $3,410
vs. Medicare Baseline: 3.75x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Tristar Horizon Medical Center is $401. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,410. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.75x the Medicare baseline. Located in 111 Highway 70 East, Dickson, TN.

Cash / Self-Pay

$3,410

Average discount available for prompt cash payment at this facility.

Insurance Median

$401

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: $3,410 (3193%)

Insurance Median: $401 (375%)

Cash: $3,410 (3193% of Medicare)

Ins. Median: $401 (375% 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 375% of the Medicare baseline (a markup of 275%). 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
Blue Cross Blue Shield	$64 - $115	60%
Humana	$129 - $852	121%
Aetna	$148 - $1,705	139%
United	$155 - $1,534	145%
Cigna	$231 - $2,728	216%
Kentucky Labor Cabinet	$628	588%
Apex Health	$648	607%
Nhc Advantage, Inc.	$648	607%
Pruitt Health (Allyalign)	$648	607%
Centurion	$1,405	1315%
Bgfh Singlesource	$1,705 - $2,898	1596%
Employers Health Network	$2,387	2235%
Odom'S Tn Pride Sausage	$2,557	2394%
Multiplan	$3,069	2873%
Beech Street	$3,137	2937%

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 $3,410.
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 Tristar Horizon 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.