CMS Price Transparency Data

Ultrasound, pelvis

Facility: Northwestern Medicine Marianjoy Rehabilitation Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $1,294
Cash Discount Price: $1,510
vs. Medicare Baseline: 12.11x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Northwestern Medicine Marianjoy Rehabilitation Hospital is $1,294. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,510. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 12.11x the Medicare baseline. Located in 26W171 Roosevelt Rd, Wheaton, IL.

Cash / Self-Pay

$1,510

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,294

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: $1,510 (1414%)

Insurance Median: $1,294 (1211%)

Cash: $1,510 (1414% of Medicare)

Ins. Median: $1,294 (1211% 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 1211% of the Medicare baseline (a markup of 1111%). 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	$906 - $2,157	848%
Imagine Health [6032]	$906	848%
Cigna	$1,078 - $1,294	1009%
The Alliance [1703]	$1,172	1097%
Blue Cross Blue Shield	$1,176 - $1,402	1101%
Humana	$1,294 - $2,157	1211%
Healthlink [125]	$1,359	1272%
First Health Plan [6034]	$1,443 - $2,157	1351%
Multiplan/Phcs [142]	$1,726 - $2,157	1616%
Health'S Finest Network [126]	$1,877	1757%
UnitedHealthcare	$2,157	2019%

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 $1,510.
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 Northwestern Medicine Marianjoy Rehabilitation 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.