CMS Price Transparency Data

Ultrasound, pelvis

Facility: Phoenixville Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $238
Cash Discount Price: $326
vs. Medicare Baseline: 2.23x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Phoenixville Hospital is $238. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $326. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.23x the Medicare baseline. Located in 140 Nutt Road, Phoenixville, PA.

Cash / Self-Pay

$326

Average discount available for prompt cash payment at this facility.

Insurance Median

$238

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: $326 (305%)

Insurance Median: $238 (223%)

Cash: $326 (305% of Medicare)

Ins. Median: $238 (223% 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 223% of the Medicare baseline (a markup of 123%). 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
Health Partners	$58	54%
Pa Health And Wellness	$58	54%
Upmc	$65 - $93	61%
Aetna	$79 - $238	74%
Keystone First	$83	78%
Geisinger	$92	86%
Health America	$138	129%
Blue Cross Blue Shield	$294 - $412	275%
UnitedHealthcare	$314	294%
First Health	$1,174	1099%
Devon	$1,279	1197%

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 $326.
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 Phoenixville 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.