CMS Price Transparency Data

Ultrasound, pelvis

Facility: Sanford Luverne Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $690
Cash Discount Price: $742
vs. Medicare Baseline: 6.46x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Sanford Luverne Medical Center is $690. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $742. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.46x the Medicare baseline. Located in 1600 N Kniss Avenue P O Box 1019, Luverne, MN.

Cash / Self-Pay

$742

Average discount available for prompt cash payment at this facility.

Insurance Median

$690

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: $742 (695%)

Insurance Median: $690 (646%)

Cash: $742 (695% of Medicare)

Ins. Median: $690 (646% 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 646% of the Medicare baseline (a markup of 546%). 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	$112 - $814	105%
Blue Cross Blue Shield	$224 - $858	210%
Sanford Health Plan Align	$326	305%
Aetna	$353 - $806	330%
Health Partners	$353 - $742	330%
Medicare (plans)	$353	330%
UnitedHealthcare	$353 - $774	330%
Primewest	$360 - $438	337%
Sanford Health Plan	$497 - $584	465%
Security Health Plan	$510	477%
Medica	$815 - $877	763%
Cigna	$834	781%
First Choice Health Network	$834	781%
Healthez	$834	781%
Multiplan	$834	781%

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 $742.
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 Luverne 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.