CMS Price Transparency Data

Ultrasound, pelvis

Facility: Stoughton Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $587
Cash Discount Price: $835
vs. Medicare Baseline: 5.50x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Stoughton Hospital is $587. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $835. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.50x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$835

Average discount available for prompt cash payment at this facility.

Insurance Median

$587

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: $835 (782%)

Insurance Median: $587 (550%)

Cash: $835 (782% of Medicare)

Ins. Median: $587 (550% 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 550% of the Medicare baseline (a markup of 450%). 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
Medicaid / KanCare	$199	186%
Tricare	$361	338%
Healthnet Mcr Adv - All Plans	$404	378%
Dean Health Insurance Med Adv	$425	398%
Humana	$425 - $1,366	398%
Quartz Mcr Adv	$425	398%
Security Health/First Health - All Plans	$425	398%
Aetna	$455 - $1,290	426%
Dean Health Insurance Comm - All Other Plans	$570	534%
Dean Health Insurance Epo	$570	534%
Quartz Health Solutions - All Other Lans	$587	550%
UnitedHealthcare	$668 - $1,214	625%
Alliance - All Plans	$880	824%
Geha - All Plans	$1,138	1065%
Cigna	$1,214	1137%
Wisconsin Ppo Ppa Direct - All Plans	$1,214	1137%
Blue Cross Blue Shield	$1,321	1237%
Wps - All Plans	$1,366	1279%

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 $835.
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 Stoughton 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.