CMS Price Transparency Data

Ultrasound, pelvis

Facility: Tulsa Spine & Specialty Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $128
Cash Discount Price: $78
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Tulsa Spine & Specialty Hospital is $128. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.20x the Medicare baseline. Located in 6901 South Olympia Avenue, Tulsa, OK.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$128

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: $78 (73%)

Insurance Median: $128 (120%)

Cash: $78 (73% of Medicare)

Ins. Median: $128 (120% 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
Black Lung [6055]	$78	73%
Healthcare Highways [2210]	$78 - $128	73%
Lucent Health [6000]	$78	73%
Oncology Patient Assistance Programs [2295]	$78	73%
Oscar Insurance Company [7005]	$78	73%
Osma Health Network [2345]	$78	73%
Healthscope Benefits [2290]	$80	75%
UnitedHealthcare	$80	75%
Resource One Administrators [2815]	$128	120%
Universal Fidelity [2085]	$128	120%
Web Tpa [2115]	$128	120%
Aetna	$137	128%
Allied Benefit Systems Inc [1030]	$137	128%
Coresource [1315]	$137	128%
Coventry Healthcare [1320]	$137	128%
Meritain Health [1655]	$137	128%
The Kempton Group Administrators [2905]	$140	131%
First Health [1375]	$192	180%
Medica [2910]	$192	180%
Multiplan [1680]	$192	180%
Cigna	$202	189%
National Association Of Letter Carriers [1695]	$202	189%
Pba [1775]	$202	189%

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 $78.
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 Tulsa Spine & Specialty 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.