CMS Price Transparency Data

Ultrasound, pelvis

Facility: Advocate Trinity Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $469
Cash Discount Price: $435
vs. Medicare Baseline: 4.39x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Advocate Trinity Hospital is $469. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $435. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.39x the Medicare baseline. Located in 2320 E 93Rd St, Chicago, IL.

Cash / Self-Pay

$435

Average discount available for prompt cash payment at this facility.

Insurance Median

$469

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: $435 (407%)

Insurance Median: $469 (439%)

Cash: $435 (407% of Medicare)

Ins. Median: $469 (439% 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 439% of the Medicare baseline (a markup of 339%). 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
Ambetter / Centene	$161	151%
Molina	$161	151%
Oscar Health Hmo	$166	155%
Hstechnology	$213	199%
UnitedHealthcare	$214 - $537	200%
Cigna	$329	308%
Advocate Employee	$343 - $380	321%
Aetna	$469	439%
Private Healthcare Systems	$539 - $696	505%
Blue Cross Blue Shield	$613 - $809	574%
Multiplan	$696	652%

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 $435.
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 Advocate Trinity 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.