CMS Price Transparency Data

Ultrasound, pelvis

Facility: Lewisgale Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $2,099
Cash Discount Price: $2,999
vs. Medicare Baseline: 19.65x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Lewisgale Medical Center is $2,099. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,999. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 19.65x the Medicare baseline. Located in 1900 Electric Road, Salem, VA.

Cash / Self-Pay

$2,999

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,099

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: $2,999 (2808%)

Insurance Median: $2,099 (1965%)

Cash: $2,999 (2808% of Medicare)

Ins. Median: $2,099 (1965% 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 1965% of the Medicare baseline (a markup of 1865%). 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	$148 - $551	139%
United	$245 - $1,350	229%
Cigna	$522	489%
Lifeworks	$570	534%
Universal Healthcare Group	$660	618%
Virginia Health Network	$1,050 - $2,129	983%
Naphcare	$1,500	1404%
Greenvbrier Sporting Club	$1,799	1684%
Graham-White Manufacturing	$2,099	1965%
Richfield Nursing Center	$2,099	1965%
Corvel	$2,159	2021%
Community Care Network	$2,249	2106%
Richfield Retirement Community	$2,249	2106%
Csx Hotels	$2,399	2246%
Occunet Workers Comp	$2,399	2246%
One Health Plan	$2,399	2246%
Patients Choice	$2,639	2471%
4Most	$2,699	2527%
Alleghany Highland Community	$2,699	2527%
American Postal Workers Union	$2,699	2527%
C&O Employees Hospital Assn	$2,699	2527%
Multiplan	$2,699	2527%
Phcs	$2,699	2527%
Star Transportation	$2,699	2527%

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 $2,999.
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 Lewisgale 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.