CMS Price Transparency Data

Ultrasound, pelvis

Facility: Forks Community Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $650
Cash Discount Price: $1,172
vs. Medicare Baseline: 6.09x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Forks Community Hospital is $650. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,172. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.09x the Medicare baseline. Located in 530 Bogachiel Way, Forks, WA.

Cash / Self-Pay

$1,172

Average discount available for prompt cash payment at this facility.

Insurance Median

$650

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: $1,172 (1097%)

Insurance Median: $650 (609%)

Cash: $1,172 (1097% of Medicare)

Ins. Median: $650 (609% 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 609% of the Medicare baseline (a markup of 509%). 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
Medicaid / KanCare	$225 - $836	211%
Coordinated Care (Mco) Mcd-All Plans	$243 - $852	228%
UnitedHealthcare	$289 - $1,938	271%
Community Health Network Mcr-All Other Plans	$292 - $1,026	273%
Humana	$292 - $1,026	273%
Tricare	$292 - $1,026	273%
Triwest-All Plans	$292 - $1,026	273%
Medicare (plans)	$318	298%
Ambetter / Centene	$339 - $1,190	317%
Wellcare Med Adv - All Plans	$339 - $1,190	317%
Regence-All Other Plans	$374 - $1,313	350%
Community Health Exchange	$422 - $1,482	395%
Molina Commercial-All Other Plans	$598 - $2,098	560%
Aetna	$618 - $2,166	579%
Blue Cross Blue Shield	$618 - $2,166	579%
Cigna	$650 - $2,280	609%
First Choice-All Plans	$650 - $2,280	609%

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 $1,172.
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 Forks 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.