CMS Price Transparency Data

Ultrasound, pelvis

Facility: Lakewood Health System

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $284
Cash Discount Price: $249
vs. Medicare Baseline: 2.66x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Lakewood Health System is $284. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $249. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.66x the Medicare baseline. Located in 49725 County Road 83, Staples, MN.

Cash / Self-Pay

$249

Average discount available for prompt cash payment at this facility.

Insurance Median

$284

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: $249 (233%)

Insurance Median: $284 (266%)

Cash: $249 (233% of Medicare)

Ins. Median: $284 (266% 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 266% of the Medicare baseline (a markup of 166%). 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
Ucare Msho/Special Needs	$21 - $297	20%
Blue Cross Blue Shield	$32 - $531	30%
Humana	$32 - $291	30%
Medica Msho/Mcr Adv	$32 - $288	30%
Ucare Mcr Adv	$32 - $297	30%
UnitedHealthcare	$32 - $642	30%
Health Partners - All Plans	$49 - $678	46%
Ucare Individual/Family - All Other Plans	$51 - $332	48%
Medica Choice Care	$56 - $352	52%
Medica Choice/Focus/Ifb/Mhps - All Other Plans	$56 - $645	52%
Preferred One Hmo	$63 - $685	59%
Preferred One Ppo - All Other Plans	$66 - $685	62%

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 $249.
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 Lakewood Health System 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.