CMS Price Transparency Data

Ultrasound, pelvis

Facility: St Gabriels Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $385
Cash Discount Price: $392
vs. Medicare Baseline: 3.60x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at St Gabriels Hospital is $385. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $392. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.60x the Medicare baseline. Located in 815 Southeast Second Street, Little Falls, MN.

Cash / Self-Pay

$392

Average discount available for prompt cash payment at this facility.

Insurance Median

$385

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: $392 (367%)

Insurance Median: $385 (360%)

Cash: $392 (367% of Medicare)

Ins. Median: $385 (360% 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 360% of the Medicare baseline (a markup of 260%). 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
Blue Cross Blue Shield	$202 - $385	189%
Health Partners	$223 - $405	209%
Medica	$234 - $567	219%
Humana	$243	228%
Ucare	$255 - $594	239%
United	$493 - $540	462%
Multiplan	$641	600%
Sanford Health Plan	$641	600%

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 $392.
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 St Gabriels 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.