CMS Price Transparency Data

Ultrasound, pelvis

Facility: St Marys Good Samaritan Hospital

Billing Code: 76856 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$222

about 2.1× the $107 Medicare rate · typically $99–$486

modeled estimate · not a bill or quote

Medicare pays $107 Fair price $222 Cash price $498 Hospital's list price $766

How we calculate the fair BaseRate →

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$207 - $2,632	194%
Blue Cross Blue Shieldmajor	$148 - $553	139%
Aetnamajor	$207 - $613	194%
Cignamajor	$207 - $628	194%
Humanamajor	$207 - $574	194%
Kaiser Permanentemajor	$207	194%
Ambetter (Centene)	$207	194%
Amerigroup	$766	717%
CareSource	$207	194%
Molina	$207	194%
WellCare	$86 - $207	81%
+ 5 smaller / regional plans	$207 - $689

Government programs also on file: Medicaid, Military & VA.

Excludes 5 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 498), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 76856.

Insurance Before you use insurance

Call your insurance company to confirm St Marys Good Samaritan Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 76856.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at St Marys Good Samaritan Hospital

Compare: Ultrasound, pelvis at other GA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.