CMS Price Transparency Data

Ultrasound, pelvis

Facility: Saratoga Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $36
Cash Discount Price: $161
vs. Medicare Baseline: 0.34x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Saratoga Hospital is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $161. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.34x the Medicare baseline. Located in 211 Church Street, Saratoga Springs, NY.

Cash / Self-Pay

$161

Average discount available for prompt cash payment at this facility.

Insurance Median

$36

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: $161 (151%)

Insurance Median: $36 (34%)

Cash: $161 (151% of Medicare)

Ins. Median: $36 (34% 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 - $1,736	20%
Blue Cross Blue Shield	$23 - $1,427	22%
Fidelis	$23 - $1,736	22%
Medicare (plans)	$23 - $31	22%
Tricare	$26 - $31	24%
Hamaspik	$29 - $1,813	27%
Medicaid / KanCare	$29	27%
Aetna	$31 - $570	29%
Emblem Health Ghi	$31 - $34	29%
Mvp	$31 - $58	29%
UnitedHealthcare	$31 - $1,048	29%
Blue Shield Highmark	$35 - $40	33%
Cigna	$48 - $58	45%
Mvp Commercial	$99 - $815	93%
Blue Shield	$111 - $344	104%
Emblem	$126 - $152	118%
Nascentia Health Options	$148	139%
Empire Plan Nyship	$153 - $815	143%
Multiplan	$164 - $989	154%
Magnacare	$197 - $1,106	184%
Mvp Essential Plan	$771 - $1,543	722%
Mvp Govt Programs	$771	722%

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 $161.
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 Saratoga 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.