CMS Price Transparency Data

Ultrasound, pelvis

Facility: Adventist Health St Helena

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $856
Cash Discount Price: $281
vs. Medicare Baseline: 8.01x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Adventist Health St Helena is $856. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $281. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.01x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$281

Average discount available for prompt cash payment at this facility.

Insurance Median

$856

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: $281 (263%)

Insurance Median: $856 (801%)

Cash: $281 (263% of Medicare)

Ins. Median: $856 (801% 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 801% of the Medicare baseline (a markup of 701%). 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 Shield Bh Mcr Adv	$36 - $139	34%
Blue Shield Mcr Adv	$36 - $139	34%
Kaiser Mcr Adv	$36 - $139	34%
Tricare	$36 - $139	34%
Ah Employee Health Plan - All Plans	$40 - $250	37%
Cigna	$42 - $2,098	39%
Blue Shield Epn-All Other Plans	$43 - $1,235	40%
Interplan-All Plans	$43 - $1,704	40%
Kaiser-All Other Plans	$43 - $2,150	40%
Blue Shield Non-Epn	$45 - $1,217	42%
Western Growers-All Plans	$53 - $1,390	50%
Medi-Cal	$68	64%
Phcs-All Plans	$78 - $1,442	73%
Va Medi-Cal	$97	91%
Health Management Network-All Plans	$120 - $2,229	112%
Three Rivers-All Plans	$127 - $2,360	119%
UnitedHealthcare	$139 - $1,672	130%
Va Mcr - All Other Plans	$139	130%
Aetna	$143 - $595	134%
Blue Cross Blue Shield	$380 - $507	356%
Blue Shield Behav Hlth	$843 - $1,180	789%
Healthnet-All Plans	$1,148 - $1,608	1075%
Choicecare-All Plans	$1,311 - $1,835	1227%
Beech Street-All Plans	$1,405 - $1,966	1315%
Galaxy Network-All Plans	$1,686 - $2,360	1579%

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 $281.
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 Adventist Health St Helena 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.