CMS Price Transparency Data

Ultrasound, pelvis

Facility: Jefferson Healthcare

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $274
Cash Discount Price: $383
vs. Medicare Baseline: 2.57x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Jefferson Healthcare is $274. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $383. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.57x the Medicare baseline. Located in 834 Sheridan Street, Port Townsend, WA.

Cash / Self-Pay

$383

Average discount available for prompt cash payment at this facility.

Insurance Median

$274

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: $383 (359%)

Insurance Median: $274 (257%)

Cash: $383 (359% of Medicare)

Ins. Median: $274 (257% 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 257% of the Medicare baseline (a markup of 157%). 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
Tricare	$33 - $300	31%
Chpw Mcr Adv	$35 - $324	33%
Aetna	$37 - $771	35%
Medicare (plans)	$38 - $306	36%
Molina Mcr Adv	$38 - $300	36%
Molina Marketplace-All Other Plans	$41 - $375	38%
Chpw Commercial-All Other Plans	$49 - $728	46%
Coord Care Comm/Exchge-All Other Plans	$53 - $771	50%
Chpw Mcaid	$65 - $268	61%
Molina Mcaid	$65 - $274	61%
Amerigroup Mcaid-All Plans	$67 - $282	63%
Regence-All Other Plans	$76 - $643	71%
Premera-All Plans	$86 - $728	81%
Cigna	$91 - $771	85%
Coord Care Mcaid Ip/Op Only	$287	269%
UnitedHealthcare	$480	449%
Coord Care Cascade Ip/Op Only	$771	722%

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 $383.
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 Jefferson Healthcare 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.