CMS Price Transparency Data

Ultrasound, pelvis

Facility: Fort Memorial Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $157
Cash Discount Price: $225
vs. Medicare Baseline: 1.47x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Fort Memorial Hospital is $157. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $225. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.47x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$225

Average discount available for prompt cash payment at this facility.

Insurance Median

$157

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: $225 (211%)

Insurance Median: $157 (147%)

Cash: $225 (211% of Medicare)

Ins. Median: $157 (147% 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
Humana	$32 - $104	30%
Molina	$33 - $104	31%
UnitedHealthcare	$37 - $117	35%
Blue Cross Blue Shield	$68 - $300	64%
Dean Health Plan	$68 - $851	64%
Medicaid / KanCare	$68	64%
Quartz	$68 - $1,035	64%
Managed Health Services	$74	69%
Fort Care	$102 - $324	95%
Medicare (plans)	$102	95%
Aetna	$127 - $806	119%
Veteran Evaluation Services	$127	119%
Group Health Cooperative	$204 - $695	191%
Alliance	$226 - $771	212%
Mercycare	$234 - $800	219%
Trilogy	$277 - $945	259%
Cigna	$299 - $1,021	280%
Centivo	$480 - $500	449%

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 $225.
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 Fort Memorial 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.