CMS Price Transparency Data

Ultrasound, pelvis

Facility: Holy Family Memorial

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $528
Cash Discount Price: $449
vs. Medicare Baseline: 4.94x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Holy Family Memorial is $528. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $449. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.94x the Medicare baseline. Located in 2300 Western Ave, Manitowoc, WI.

Cash / Self-Pay

$449

Average discount available for prompt cash payment at this facility.

Insurance Median

$528

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: $449 (420%)

Insurance Median: $528 (494%)

Cash: $449 (420% of Medicare)

Ins. Median: $528 (494% 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 494% of the Medicare baseline (a markup of 394%). 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	$101 - $579	95%
Community Care Incorporated	$101	95%
Health Partners	$101 - $530	95%
Humana	$101	95%
Icare	$101	95%
Molina	$101 - $109	95%
Network Health Plan	$101 - $434	95%
Security Health Plan	$101 - $653	95%
UnitedHealthcare	$101 - $647	95%
Allwell	$103	96%
Medical College Of Wisconsin	$269	252%
Centivo	$326 - $375	305%
Dean Health Plan	$408	382%
Health Payment Systems	$460	431%
Sheboygan Employers Health Network	$490	459%
Chorus Community Health Plan	$525	492%
Trilogy	$539	505%
Cigna	$588	551%
Wps Health Plan	$604	565%
Aspirus	$653	611%
Healtheos	$653	611%
Multiplan/Private Healthcare Systems	$653	611%
Preferred One	$653	611%
Healthsmart	$677	634%
First Health Network	$718	672%

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 $449.
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 Holy Family Memorial 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.