CMS Price Transparency Data

Ultrasound, pelvis

Facility: Duke University Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $192
Cash Discount Price: $485
vs. Medicare Baseline: 1.80x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Duke University Hospital is $192. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $485. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.80x the Medicare baseline. Located in 2301 Erwin Rd, Durham, NC.

Cash / Self-Pay

$485

Average discount available for prompt cash payment at this facility.

Insurance Median

$192

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: $485 (454%)

Insurance Median: $192 (180%)

Cash: $485 (454% of Medicare)

Ins. Median: $192 (180% 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.

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
Blue Cross Blue Shield	$93 - $819	87%
UnitedHealthcare	$93 - $577	87%
Aetna	$95 - $620	89%
Humana	$96 - $696	90%
Troy Health	$104	97%
Voans	$104	97%
Cigna	$106 - $819	99%
Liberty	$106	99%
Amerihealth	$132 - $206	124%
Carolina Complete Health	$132 - $206	124%
Trillium	$132 - $206	124%
Alliance Health	$146 - $206	137%
Partners	$146 - $206	137%
Medcost	$349 - $356	327%
Sentara	$510	477%

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 $485.
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 Duke University 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.