CMS Price Transparency Data

Ultrasound, pelvis

Facility: Woodlawn Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $252
Cash Discount Price: $836
vs. Medicare Baseline: 2.36x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Woodlawn Hospital is $252. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $836. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.36x the Medicare baseline. Located in 1400 E 9Th St, Rochester, IN.

Cash / Self-Pay

$836

Average discount available for prompt cash payment at this facility.

Insurance Median

$252

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: $836 (783%)

Insurance Median: $252 (236%)

Cash: $836 (783% of Medicare)

Ins. Median: $252 (236% 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 236% of the Medicare baseline (a markup of 136%). 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
Blue Cross Blue Shield	$63 - $893	59%
Caresource Mcaid Hww	$63	59%
Mdwise Excel Hhw & Hcc	$63	59%
Mhs Mcaid Hcc	$63	59%
Mhs Mcaid Hhw	$63	59%
UnitedHealthcare	$63 - $847	59%
Aetna	$245 - $1,058	229%
Caresource Mcaid Hip	$245	229%
Caresource Mcr Adv	$245	229%
Humana	$245 - $864	229%
Mdwise Mcaid Excel Hip	$245	229%
Mhs Exch Mrktplce-All Other Plans	$245	229%
Mhs Mcaid Hip	$245	229%
Mhs Mcr Adv	$250	234%
Caresource Exch - All Other Plans	$319	299%
Ambetter / Centene	$326	305%
Partners Direct Health-All Plans	$758	710%
Cigna	$798 - $947	747%
Parkview Health Plans-All Plans	$836	783%
Sagamore All Other Grps - All Other Plans	$936	876%
Encore Comm-All Plans	$947	887%
Phcs/Multiplan-All Plans	$1,036	970%
Community Health Alliance-All Plans	$1,058	991%

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 $836.
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 Woodlawn 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.