CMS Price Transparency Data

Ultrasound, pelvis

Facility: Charleston Area Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $629
Cash Discount Price: $1,174
vs. Medicare Baseline: 5.89x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Charleston Area Medical Center is $629. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,174. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.89x the Medicare baseline. Located in 501 Morris Street, Charleston, WV.

Cash / Self-Pay

$1,174

Average discount available for prompt cash payment at this facility.

Insurance Median

$629

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: $1,174 (1099%)

Insurance Median: $629 (589%)

Cash: $1,174 (1099% of Medicare)

Ins. Median: $629 (589% 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 589% of the Medicare baseline (a markup of 489%). 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	$51 - $1,249	48%
The Health Plan Of West Virginia Inc.	$51 - $1,236	48%
Unicare Health Plan Of West Virginia Inc.	$51 - $321	48%
Tricare	$59 - $764	55%
Integrated Medical Solutions	$89 - $621	83%
Triwest Va	$93 - $309	87%
Blue Cross Blue Shield	$96 - $1,162	90%
Choicecare Network	$96 - $1,249	90%
Optimum Choice Inc.	$96 - $107	90%
Three Rivers Providers Network	$96 - $1,236	90%
UnitedHealthcare	$96 - $1,249	90%
Healthsmart	$97 - $1,249	91%
Multiplan	$97 - $1,249	91%
Cigna	$98 - $1,185	92%
Caresource	$99 - $796	93%
City Of Charleston	$99 - $956	93%
Naphcare	$99 - $637	93%
West Virginia Senior Advantage Inc.	$101 - $334	95%

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 $1,174.
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 Charleston Area 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.