CMS Price Transparency Data

Ultrasound, pelvis

Facility: Los Robles Hospital & Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $800
Cash Discount Price: $2,328
vs. Medicare Baseline: 7.49x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Los Robles Hospital & Medical Center is $800. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,328. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.49x the Medicare baseline. Located in 215 W Janss Rd, Thousand Oaks, CA.

Cash / Self-Pay

$2,328

Average discount available for prompt cash payment at this facility.

Insurance Median

$800

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: $2,328 (2180%)

Insurance Median: $800 (749%)

Cash: $2,328 (2180% of Medicare)

Ins. Median: $800 (749% 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 749% of the Medicare baseline (a markup of 649%). 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
Brand New Day	$75	70%
Gold Coast Health Plan	$75	70%
Medcare Partners	$159 - $377	149%
Blue Cross Blue Shield	$162 - $574	152%
Aetna	$187 - $2,515	175%
United	$245 - $707	229%
Cigna	$424	397%
First Health	$719 - $2,012	673%
Choicecare Network	$740 - $1,760	693%
Blue Shield	$755 - $1,078	707%
Multiplan	$845 - $2,389	791%
Ppo Next	$845 - $2,012	791%
Interplan Corporation	$951 - $2,263	890%
Ventura County Foundation	$951 - $2,263	890%

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 $2,328.
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 Los Robles Hospital & 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.