CMS Price Transparency Data

Ultrasound, pelvis

Facility: Fostoria Community Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $586
Cash Discount Price: $732
vs. Medicare Baseline: 5.49x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Fostoria Community Hospital is $586. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $732. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.49x the Medicare baseline. Located in 501 Van Buren Street, Fostoria, OH.

Cash / Self-Pay

$732

Average discount available for prompt cash payment at this facility.

Insurance Median

$586

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: $732 (685%)

Insurance Median: $586 (549%)

Cash: $732 (685% of Medicare)

Ins. Median: $586 (549% 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 549% of the Medicare baseline (a markup of 449%). 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
Meridian Health Plan Of Mi	$57	53%
Paramount Health Care	$94 - $597	88%
Blue Cross Blue Shield	$97 - $730	91%
Health Alliance Plan	$97 - $844	91%
Health Value Management	$97 - $244	91%
Buckeye Community Health Plan	$99 - $251	93%
Buckeye Community Health Plan Inc	$110 - $409	103%
Aetna	$111 - $754	104%
Dayton Area Health Plan Dba Caresource	$152 - $467	142%
UnitedHealthcare	$221 - $673	207%
Amerihealth	$232	217%
Veterans Affairs	$248	232%
Medical Mutual Of Ohio	$636 - $677	595%
Frontpath Health Coalition	$649	608%
Ohio Health Choice	$732	685%
Ohio Ppo Connect	$732 - $844	685%
Health Ohio Network	$890	833%
Connecticut General Life Insurance Company	$899	842%

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 $732.
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 Fostoria 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.