CMS Price Transparency Data

Ultrasound, pelvis

Facility: Adventist Health Tulare

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $131
Cash Discount Price: $152
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Adventist Health Tulare is $131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $152. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.23x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$152

Average discount available for prompt cash payment at this facility.

Insurance Median

$131

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: $152 (142%)

Insurance Median: $131 (123%)

Cash: $152 (142% of Medicare)

Ins. Median: $131 (123% 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.

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
Blue Shield Mcare	$33 - $134	31%
Fhcn Pace Mcr Adv - All Plans	$33 - $134	31%
Medicare (plans)	$33 - $134	31%
Tricare	$33 - $134	31%
UnitedHealthcare	$33 - $1,063	31%
Upn-United Physcn Ntwrk Mcr Adv Profee Only-All Ot	$33	31%
Ah Employee Health Plan - All Plans	$36 - $242	34%
Incentive Hlth - All Plans	$36 - $242	34%
Blue Shield Epn	$40 - $464	37%
Hs Interplan-All Plans	$41 - $983	38%
Cigna	$42 - $679	39%
Blue Shield-All Other Plans	$43 - $641	40%
Cal Forensic Med Grp - All Plans	$43 - $175	40%
Blue Cross Blue Shield	$46 - $448	43%
Healthnet Hmo/Ppo - All Other Plans	$48 - $358	45%
Ccipa Medi-Cal - All Plans	$68 - $126	64%
Healthnet Medi-Cal	$68 - $127	64%
Medi-Cal	$68 - $97	64%
Upn-United Physcn Ntwrk Mcal Profee Only	$68	64%
Aetna	$83 - $518	78%
Dignity Mcal Op Only	$107	100%
Independence Op Only - All Plans	$107	100%
Dignity Mcr Op Only - All Other Plans	$134	125%
Prime Health - All Plans	$134	125%
Prison Hlthcre - All Plans	$172	161%
Bright Health - All Plans	$195	183%
Western Growers - All Plans	$675	632%
Network By Design-All Plans	$1,027	962%
Multiplan - All Plans	$1,247	1167%

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 $152.
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 Adventist Health Tulare 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.