CMS Price Transparency Data

Ultrasound, pelvis

Facility: Black River Memorial Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $360
Cash Discount Price: $764
vs. Medicare Baseline: 3.37x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Black River Memorial Hospital is $360. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $764. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.37x the Medicare baseline. Located in 711 W Adams St, Black River Falls, WI.

Cash / Self-Pay

$764

Average discount available for prompt cash payment at this facility.

Insurance Median

$360

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: $764 (715%)

Insurance Median: $360 (337%)

Cash: $764 (715% of Medicare)

Ins. Median: $360 (337% 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 337% of the Medicare baseline (a markup of 237%). 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
Humana	$30 - $790	28%
UnitedHealthcare	$30 - $801	28%
Blue Cross Blue Shield	$31 - $747	29%
Group Health Cooperative Of Eau Claire	$31 - $824	29%
My Choice Wisconsin, Inc.	$31 - $433	29%
Quartz Health Solutions, Inc	$31 - $773	29%
Security Health Plan	$32 - $793	30%
The Alliance	$32 - $815	30%
Multiplan	$97 - $841	91%
Corvel	$236 - $518	221%
Triology Health Solutions	$348 - $807	326%
Medica	$361 - $793	338%
Association Benefits Solution	$368 - $807	345%
Family Health Center Of Marshfield	$368 - $807	345%
First Health Group Corporation	$368 - $807	345%
Provider Network Of America	$368 - $807	345%
Cigna	$375 - $824	351%
Cofinity	$375 - $824	351%
Coventry Health Care	$375 - $824	351%
Custom Benefit Administrators	$375 - $824	351%
Healthpartners, Inc.	$375 - $824	351%
Wisconsin Physicians Service Insurance Corp	$375 - $824	351%
Chorus	$379 - $832	355%

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 $764.
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 Black River 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.