CMS Price Transparency Data

Ultrasound, pelvis

Facility: Glens Falls Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $126
Cash Discount Price: $157
vs. Medicare Baseline: 1.18x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Glens Falls Hospital is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $157. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.18x the Medicare baseline. Located in 100 Park Street, Glens Falls, NY.

Cash / Self-Pay

$157

Average discount available for prompt cash payment at this facility.

Insurance Median

$126

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: $157 (147%)

Insurance Median: $126 (118%)

Cash: $157 (147% of Medicare)

Ins. Median: $126 (118% 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
Aetna	$35 - $271	33%
Cdphp	$66 - $1,749	62%
Medicare (plans)	$73 - $97	68%
UnitedHealthcare	$73 - $337	68%
Medicaid / KanCare	$81 - $97	76%
Emblem Health Ghi	$83 - $97	78%
Blue Cross Blue Shield	$89 - $777	83%
Tricare	$93 - $97	87%
Mvp	$96 - $1,632	90%
Blue Shield	$97 - $306	91%
Fidelis	$97 - $1,749	91%
Mvp Commercial	$99 - $422	93%
Blue Shield Highmark	$121 - $302	113%
Magnacare	$126 - $297	118%
Cigna	$150 - $182	140%
Hamaspik	$224 - $257	210%
Nascentia Health Options	$224 - $257	210%
Emblem	$275 - $317	257%
Empire Plan Nyship	$292 - $337	273%
Multiplan	$292 - $337	273%

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 $157.
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 Glens Falls 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.