CMS Price Transparency Data

Ultrasound, pelvis

Facility: Hospital for Special Surgery

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $557
Cash Discount Price: $533
vs. Medicare Baseline: 5.21x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Hospital for Special Surgery is $557. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $533. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.21x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$533

Average discount available for prompt cash payment at this facility.

Insurance Median

$557

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: $533 (499%)

Insurance Median: $557 (521%)

Cash: $533 (499% of Medicare)

Ins. Median: $557 (521% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 521% of the Medicare baseline (a markup of 421%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
UnitedHealthcare	$25 - $853	23%
Fidelis	$26 - $28	24%
Metro Plus	$35 - $36	33%
Emblem	$36 - $48	34%
Blue Cross Blue Shield	$48 - $853	45%
Horizon	$58	54%
Nyship	$62	58%
Cigna	$72 - $688	67%
Aetna	$84 - $853	79%
Fidelis Essential [1323]	$125	117%
Oxford [1096]	$422 - $544	395%
Emblem Health [1043]	$520 - $557	487%
Student Resources [1103]	$520 - $671	487%
Connecticare [1039]	$557 - $853	521%
Apwu [1016]	$584 - $688	547%
Nalc [1090]	$584 - $688	547%
Qualcare [1101]	$584 - $688	547%
Wellfleet [1361]	$584 - $688	547%
Harvard Pilgrim [1057]	$598 - $771	560%
Geha [1053]	$671	628%
Christian Brothers [1034]	$841 - $853	787%
Meritain Health [1085]	$841 - $853	787%
Nippon Life [1092]	$841 - $853	787%
Webtpa [1356]	$841 - $853	787%
Affinity By Molina Health Plan [1005]	$853	799%
Medicare (plans)	$853	799%

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 $533.
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 Hospital for Special Surgery 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.