CMS Price Transparency Data

Ultrasound, pelvis

Facility: Holy Family Memorial

Billing Code: 76856 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$103

about 1.0× the $107 Medicare rate · typically $102–$212

modeled estimate · not a bill or quote

What this hospital charges insurers

$102

About the fair price

about $1 under the fair price · 1.0× Medicare

Medicare pays $107 Fair price $103 This hospital $102 Cash price $449 Hospital's list price $816

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $35 Priciest $102

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Ultrasound, pelvis is about $103 (about 1.0× the $107 Medicare rate). Holy Family Memorial charges insurers about $102, or about $449 in cash — about the fair price. Located in Manitowoc, WI.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Cigna✓ Humana AetnaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$101 - $647	95%
Blue Cross Blue Shieldmajor	$101 - $579	95%
Cignamajor	$588	551%
Humanamajor	$101	95%
Dean Health Plan	$408	382%
Health Net	$490	459%
HealthPartners	$101 - $530	95%
Molina	$101 - $109	95%
Security Health Plan	$101 - $653	95%
+ 13 smaller / regional plans	$101 - $653

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 449), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 76856.

Insurance Before you use insurance

Call your insurance company to confirm Holy Family Memorial is in-network.
Ask your insurer whether prior approval is required for CPT code 76856.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Holy Family Memorial

Compare: Ultrasound, pelvis at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.