Ultrasound, pelvis
Facility: Stafford County Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $207
- Cash Discount Price: $207
- vs. Medicare Baseline: 1.94x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Health Partners-All Plans | $197 | 184% |
| Va Ccn-All Plans | $207 | 194% |
| UnitedHealthcare | $207 | 194% |
| Humana | $207 | 194% |
| Medica Mcr- All Plans | $207 | 194% |
Consumer Guidance & Cost Commentary
For the CPT code 76856 (Ultrasound, pelvis) at Stafford County Hospital, the cash price is $207.00, which matches the facility's negotiated rate with all five listed payers, including Health Partners-All Plans, UnitedHealthcare, and Humana. This rate is significantly higher than the Medicare benchmark of $106.81, reflecting a markup of 1.9 times the federal reimbursement rate. While commercial insurance contracts often cap charges to protect members, the data indicates that for this specific service, the negotiated amount equals the cash price, meaning patients with high-deductible plans may find paying out-of-pocket directly to the hospital offers no financial advantage over using their insurance.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, it is still critical to request a full itemized bill before paying to ensure no unbundled codes or services not rendered are included. Since the cash price here is already at the negotiated floor, asking for a prompt-pay discount is unlikely to reduce the total cost further, but patients should still verify their plan's deductible status and confirm that the facility has not automatically submitted a claim that could void any potential self-pay agreement.