CMS Price Transparency Data

Ultrasound, pelvis

Facility: Albany Medical Center Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $80
Cash Discount Price: $79
vs. Medicare Baseline: 0.75x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Albany Medical Center Hospital is $80. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $79. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.75x the Medicare baseline. Located in 43 New Scotland Avenue, Mail Code 34, Albany, NY.

Cash / Self-Pay

$79

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

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: $79 (74%)

Insurance Median: $80 (75%)

Cash: $79 (74% of Medicare)

Ins. Median: $80 (75% 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
Cdphp	$21 - $1,730	20%
UnitedHealthcare	$21 - $846	20%
Empire Plan Nyship	$22 - $846	21%
Blue Cross Blue Shield	$23 - $1,730	22%
Medicare (plans)	$23 - $111	22%
Fidelis	$24 - $1,730	22%
Multiplan	$24 - $898	22%
Tricare	$26 - $97	24%
Aetna	$28 - $311	26%
Blue Shield	$28 - $816	26%
Blue Shield Highmark	$29 - $302	27%
Hamaspik	$29 - $1,807	27%
Medicaid / KanCare	$29 - $97	27%
Mvp	$31 - $769	29%
Emblem Health Ghi	$34 - $214	32%
Nascentia	$34 - $107	32%
Cigna	$48 - $182	45%
Nys Department Of Corrections	$76 - $236	71%
Nascentia Health Options	$148	139%
Emblem	$152 - $250	142%
Mvp Commercial	$242	227%
Emblem_Ghi	$250	234%
Magnacare	$253	237%
Mvp Essential Plan	$1,653	1548%

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 $79.
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 Albany Medical Center 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.