CMS Price Transparency Data

Ultrasound, pelvis

Facility: Pioneer Memorial Hospital - Cah

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $861
Cash Discount Price: $1,013
vs. Medicare Baseline: 8.06x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Pioneer Memorial Hospital - Cah is $861. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,013. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.06x the Medicare baseline. Located in 315 N Washington Ave Post Office Box 368, Viborg, SD.

Cash / Self-Pay

$1,013

Average discount available for prompt cash payment at this facility.

Insurance Median

$861

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: $1,013 (948%)

Insurance Median: $861 (806%)

Cash: $1,013 (948% of Medicare)

Ins. Median: $861 (806% 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 806% of the Medicare baseline (a markup of 706%). 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
UnitedHealthcare	$355 - $851	332%
Aetna	$800	749%
Health Partners	$841	787%
United Medical Resources	$851	797%
Avera Health Plan	$861	806%
Cigna	$861	806%
Dakotacare	$861	806%
Medica	$861	806%
Sanford Health Plan	$912	854%
Blue Cross Blue Shield	$972	910%

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 $1,013.
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 Pioneer Memorial Hospital - Cah 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.