CMS Price Transparency Data

Ultrasound, pelvis

Facility: UPMC Jameson

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $110
Cash Discount Price: $395
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at UPMC Jameson is $110. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $395. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.03x the Medicare baseline. Located in 1211 Wilmington Avenue, New Castle, PA.

Cash / Self-Pay

$395

Average discount available for prompt cash payment at this facility.

Insurance Median

$110

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: $395 (370%)

Insurance Median: $110 (103%)

Cash: $395 (370% of Medicare)

Ins. Median: $110 (103% 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
UnitedHealthcare	$53 - $432	50%
Upmc Health Plan	$84 - $334	79%
Aetna	$86 - $101	81%
Amerihealth Caritas	$99 - $109	93%
Humana	$101 - $526	95%
Geisinger	$106	99%
Cigna	$109 - $252	102%
Highmark Wholecare (Prev Gateway)	$109 - $329	102%
Pa Health & Wellness	$109 - $130	102%
Blue Cross Blue Shield	$111	104%
Occunet	$127	119%
Upmc Work Partners	$228	213%
Multiplan	$494 - $526	463%
National Provider Network	$579	542%

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 $395.
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 UPMC Jameson 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.