CMS Price Transparency Data

Ultrasound, pelvis

Facility: Holy Cross Hospital - Salt Lake

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $501
Cash Discount Price: $423
vs. Medicare Baseline: 4.69x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Holy Cross Hospital - Salt Lake is $501. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $423. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.69x the Medicare baseline. Located in 1050 East South Temple, Salt Lake City, UT.

Cash / Self-Pay

$423

Average discount available for prompt cash payment at this facility.

Insurance Median

$501

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: $423 (396%)

Insurance Median: $501 (469%)

Cash: $423 (396% of Medicare)

Ins. Median: $501 (469% 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 469% of the Medicare baseline (a markup of 369%). 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
Denver Health	$56	52%
Health Choice	$56	52%
Medicaid / KanCare	$56	52%
Rocky Mountain Health Plan	$56	52%
Uuhp	$56 - $250	52%
Humana	$64	60%
Medicare (plans)	$64	60%
Employer Direct Healthcare	$81	76%
Motivhealth	$85	80%
Blue Cross Blue Shield	$105 - $635	98%
Cigna	$112 - $847	105%
Molina	$150 - $455	140%
UnitedHealthcare	$154	144%
Centura Employee Plan	$205	192%
Pehp	$452 - $1,059	423%
Aetna	$468 - $894	438%
Wise	$550 - $561	515%
Deseret Mutual Benefit Administrators	$650	609%
Select Health	$701	656%
Multiplan	$730 - $963	683%
Emi Health	$1,059	991%

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 $423.
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 Holy Cross Hospital - Salt Lake 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.