CMS Price Transparency Data

Ultrasound, pelvis

Facility: Intermountain Health Fillmore Community Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76856
  • Insurance Median: $661
  • Cash Discount Price: $522
  • vs. Medicare Baseline: 6.19x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at Intermountain Health Fillmore Community Hospital is $661. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $522. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.19x the Medicare baseline. Located in 674 South Highway 99, Fillmore, UT.
Cash / Self-Pay
$522

Average discount available for prompt cash payment at this facility.

Insurance Median
$661

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: $522 (489%)
Insurance Median: $661 (619%)
Cash: $522 (489% of Medicare)
Ins. Median: $661 (619% 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 619% of the Medicare baseline (a markup of 519%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

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
Aetna $32 - $668 30%
American Health $32 - $320 30%
Blue Cross Blue Shield $32 - $661 30%
Health Partners Of Nevada $32 - $320 30%
Health Plan Of Nevada $32 - $619 30%
Humana $32 - $320 30%
Molina $32 - $661 30%
Selecthealth $32 - $661 30%
UnitedHealthcare $32 - $661 30%
Triwest $307 287%
Healthy U $320 - $619 300%
Awh Connected $339 - $668 317%
Byu Athletics $339 - $661 317%
Campbell Scientific $339 - $661 317%
Cigna $339 - $661 317%
Deseret Mutual $339 - $661 317%
Emi $339 - $661 317%
Emi Health $339 - $661 317%
Franklin County $339 - $661 317%
Health Utah $339 - $661 317%
Ifit $339 - $661 317%
Juniper Systems $339 - $661 317%
Lw Miller $339 - $661 317%
Managed Care Admin $339 - $661 317%
Motivhealth $339 - $661 317%
Pehp $339 - $661 317%
Prodegi Corp Benefit $339 - $661 317%
Tanner Llc $339 - $661 317%
Utah Tech $339 - $661 317%
Wise Network $339 - $661 317%
Injury Care Of Nevada $522 489%
Byu Risk Management $591 553%
Corporation Of The President $591 553%
Corvel Corporation $591 553%
Wcf Insurance $591 553%
Global Excel $661 619%
Hygeia Corporation $661 619%
Medcare International $661 619%
Springtide $661 619%
Uofu $661 619%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 674 South Highway 99, Fillmore, UT 84631
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals