CMS Price Transparency Data

Ultrasound, pelvis

Facility: Rochelle Community Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $1,152
Cash Discount Price: $1,487
vs. Medicare Baseline: 10.79x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Rochelle Community Hospital is $1,152. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,487. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.79x the Medicare baseline. Located in 900 N 2Nd St, Rochelle, IL.

Cash / Self-Pay

$1,487

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,152

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: $1,487 (1392%)

Insurance Median: $1,152 (1079%)

Cash: $1,487 (1392% of Medicare)

Ins. Median: $1,152 (1079% 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 1079% of the Medicare baseline (a markup of 979%). 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	$291 - $744	272%
Blue Cross Blue Shield	$291 - $1,487	272%
Medicaid / KanCare	$291	272%
Health Alliance Mcr Adv	$520	487%
Humana	$520 - $1,190	487%
UnitedHealthcare	$520 - $1,338	487%
Va Ccn - All Plans	$520	487%
Wellcare Mcr Adv - All Plans	$531	497%
Cigna	$1,115	1044%
Osf Dan Ppo - All Plans	$1,115	1044%
Beech Street-All Plans	$1,190	1114%
First Health - All Plans	$1,190	1114%
Health Alliance-All Other Plans	$1,190	1114%
Ecoh-All Plans	$1,264	1183%
Hfn-All Plans	$1,264	1183%
The Alliance-All Plans	$1,264	1183%
Quartz Health Solutions-All Plans	$1,309	1226%
Multiplan-All Plans	$1,398	1309%

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 $1,487.
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 Rochelle 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.