CMS Price Transparency Data

Ultrasound, pelvis

Facility: Carilion Tazewell Community Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $920
Cash Discount Price: $632
vs. Medicare Baseline: 8.61x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Carilion Tazewell Community Hospital is $920. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $632. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.61x the Medicare baseline. Located in 388 Ben Bolt Avenue, Tazewell, VA.

Cash / Self-Pay

$632

Average discount available for prompt cash payment at this facility.

Insurance Median

$920

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: $632 (592%)

Insurance Median: $920 (861%)

Cash: $632 (592% of Medicare)

Ins. Median: $920 (861% 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 861% of the Medicare baseline (a markup of 761%). 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
Aetna	$92 - $1,200	86%
Humana	$94 - $111	88%
Corvel	$96	90%
Allcare	$98	92%
Blue Cross Blue Shield	$100 - $552	94%
UnitedHealthcare	$101 - $1,477	95%
Sentara Health Plan	$103 - $1,120	96%
Abh Of Va (Formerly Coventry)	$111	104%
Abh Of Wva (Formerly Coventry)	$111	104%
Gateway - Tier 3	$994	931%
Vhn - Ultra	$1,120	1049%
Cigna	$1,147 - $1,223	1074%
Connecticare	$1,265	1184%
Vhn - Plus	$1,391	1302%
Gateway - Tier 2	$1,446	1354%
Vhn	$1,446	1354%
Integrated Health Plan	$1,536	1438%
Vhn - Link	$1,626	1522%
Gateway - Tier 1	$1,717	1608%
Vhn - Secondary Payors	$1,717	1608%
National Provider Network	$1,735	1624%

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 $632.
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 Carilion Tazewell Community Hospital 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.