CMS Price Transparency Data

Ultrasound, pelvis

Facility: Good Samaritan Medical Center LLC

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $833
Cash Discount Price: Unavailable
vs. Medicare Baseline: 7.80x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Good Samaritan Medical Center LLC is $833. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.80x the Medicare baseline. Located in 200 Exempla Cir, Lafayette, CO.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$833

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%)

Insurance Median: $833 (780%)

Ins. Median: $833 (780% 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 780% of the Medicare baseline (a markup of 680%). 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
Aarp	$106	99%
UnitedHealthcare	$106 - $1,147	99%
Kaiser Snp	$107	100%
Select Health	$107	100%
Aetna	$249 - $1,773	233%
Geha	$271 - $1,147	254%
Preferred One	$271 - $789	254%
Denv Hlth Med Plan	$278	260%
Kaiser Perm Hmo	$366 - $833	343%
Kaiser Self Funded	$455 - $833	426%
Kaiser Perm Ppo/Pos	$461 - $858	432%
Allegiance	$494	463%
Cigna	$494 - $1,977	463%
Blue Cross Blue Shield	$545 - $1,664	510%
Humana	$830	777%
Cofinity	$1,425	1334%
First Health Network	$1,425	1334%
Private Hlthcare Sys	$1,483	1388%
Multiplan Inc	$1,680	1573%

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 $X.
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 Good Samaritan Medical Center LLC 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.