CMS Price Transparency Data

Ultrasound, pelvis

Facility: M Health Fairview St John's Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $173
Cash Discount Price: $236
vs. Medicare Baseline: 1.62x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at M Health Fairview St John's Hospital is $173. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $236. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.62x the Medicare baseline. Located in 1575 Beam Avenue, Maplewood, MN.

Cash / Self-Pay

$236

Average discount available for prompt cash payment at this facility.

Insurance Median

$173

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: $236 (221%)

Insurance Median: $173 (162%)

Cash: $236 (221% of Medicare)

Ins. Median: $173 (162% 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.

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
Primewest	$22 - $103	21%
South Country Health Alliance	$22 - $103	21%
Ucare	$23 - $280	22%
Health Partners	$24 - $319	22%
Medica	$24 - $403	22%
Blue Cross Blue Shield	$25 - $359	23%
Itasca Medical Care	$25 - $103	23%
Sanford Health Plan	$30 - $348	28%
Security Health Plan	$30 - $443	28%
UnitedHealthcare	$30 - $255	28%
Wellcare	$30 - $103	28%
Hennepin Health	$34 - $114	32%
America'S Ppo	$90 - $425	84%
First Health	$98 - $484	92%
Multiplan	$101 - $502	95%
Private Healthcare Systems	$101 - $502	95%
Wisconsin Physician Services	$107 - $531	100%

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 $236.
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 M Health Fairview St John's 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.