Ultrasound, pelvis
Facility: Oakleaf Surgical Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $104
- Cash Discount Price: $1,361
- vs. Medicare Baseline: 0.97x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | $104 - $389 | 97% |
| Dean Health Plan | $104 | 97% |
| Group Health Cooperative Of Eau Claire | $104 | 97% |
| Healthpartners | $104 | 97% |
| Humana | $104 | 97% |
| Medica | $104 | 97% |
| Quartz Health Solutions | $104 | 97% |
| Security Health Plan Of Wi | $104 - $876 | 97% |
| Ucare Wi | $104 | 97% |
| UnitedHealthcare | $104 | 97% |
Consumer Guidance & Cost Commentary
For a self-pay patient, the most immediate cost for this pelvic ultrasound is $1,361 for the cash median rate. While many patients assume insurance offers the lowest price, commercial negotiated rates for this service at Oakleaf Surgical Hospital are significantly higher, with a median of $104 and a gross charge of $1,512. This discrepancy highlights that paying cash upfront can sometimes be more economical than relying on insurance, especially if the patient's plan has a high deductible or if the negotiated rate exceeds the cash price. Patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are receiving the lowest possible rate.
The pricing context for this procedure in Altoona, Wisconsin, is shaped by the facility's status as a physician-owned acute care hospital. The $1,361 cash rate provides a clear benchmark against which commercial rates can be evaluated, as the Medicare amount of $106.81 serves as the objective baseline for evaluating markup. Although the data indicates 10 payers with a median negotiated rate of $104, patients must be aware that individual plans vary widely, with the highest negotiated rate reaching $389 for some Blue Cross Blue Shield plans. It is crucial to verify specific plan details and avoid assuming that in-network status guarantees the best price, as contract dynamics can result in rates that are several times higher than the cash option.