CMS Price Transparency Data

Ultrasound, pelvis

Facility: Gillette Childrens Specialty Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $853
Cash Discount Price: $955
vs. Medicare Baseline: 7.99x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Gillette Childrens Specialty Hospital is $853. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $955. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.99x the Medicare baseline. Located in 200 University Avenue East, Saint Paul, MN.

Cash / Self-Pay

$955

Average discount available for prompt cash payment at this facility.

Insurance Median

$853

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: $955 (894%)

Insurance Median: $853 (799%)

Cash: $955 (894% of Medicare)

Ins. Median: $853 (799% 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 799% of the Medicare baseline (a markup of 699%). 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	$23 - $636	22%
Health Partners	$48 - $1,153	45%
UnitedHealthcare	$54 - $951	51%
Medica	$59 - $1,177	55%
Blue Cross Blue Shield	$62 - $1,122	58%
Aetna	$111 - $1,193	104%
Humana	$955	894%
America'S Ppo	$1,273	1192%
Geha	$1,352	1266%
Multiplan	$1,352	1266%

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 $955.
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 Gillette Childrens Specialty 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.