CMS Price Transparency Data

Ultrasound, pelvis

Facility: Sanford Sheldon Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $772
Cash Discount Price: $957
vs. Medicare Baseline: 7.23x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Sanford Sheldon Medical Center is $772. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $957. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.23x the Medicare baseline. Located in 118 North Seventh Avenue, Po Box 250, Sheldon, IA.

Cash / Self-Pay

$957

Average discount available for prompt cash payment at this facility.

Insurance Median

$772

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: $957 (896%)

Insurance Median: $772 (723%)

Cash: $957 (896% of Medicare)

Ins. Median: $772 (723% 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 723% of the Medicare baseline (a markup of 623%). 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
Sanford Health Plan Align	$341	319%
Ucare	$366 - $1,051	343%
Aetna	$370 - $1,039	346%
Blue Cross Blue Shield	$370	346%
Health Partners	$370 - $897	346%
Medicare (plans)	$370	346%
UnitedHealthcare	$370 - $999	346%
Primewest	$377	353%
Wellmark	$598 - $622	560%
Sanford Health Plan	$641 - $754	600%
Security Health Plan	$658	616%
Medica	$987 - $1,055	924%
First Choice Health Network	$1,076	1007%
Healthez	$1,076	1007%
Multiplan	$1,076	1007%

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 $957.
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 Sanford Sheldon Medical Center 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.