CMS Price Transparency Data
Ultrasound, pelvis
Facility: Pennsylvania Hospital
Billing Code: 76856 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 76856
- Insurance Median: $145
- Cash Discount Price: $982
- vs. Medicare Baseline: 1.36x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at Pennsylvania Hospital is $145. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $982. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.36x the Medicare baseline. Located in 800 Spruce Street, Philadelphia, PA.
Cash / Self-Pay
$982
Average discount available for prompt cash payment at this facility.
Insurance Median
$145
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: $982 (919%)
Insurance Median: $145 (136%)
Cash: $982 (919% of Medicare)
Ins. Median: $145 (136% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Horizon Nj Health | $24 - $320 | 22% |
| UnitedHealthcare | $30 - $1,818 | 28% |
| Pgm - Regie De L'Assurance Maladie Quebec | $33 - $418 | 31% |
| Preferred Health Care Eliance | $38 - $473 | 36% |
| Gateway Health Plan | $46 - $136 | 43% |
| Medicaid / KanCare | $46 - $1,818 | 43% |
| Pgm - Kuwait Defense | $51 - $818 | 48% |
| Devon | $55 - $818 | 51% |
| Qualcare | $55 - $691 | 51% |
| Coventry | $58 - $927 | 54% |
| Health Partners | $58 - $1,818 | 54% |
| Pgm - Chop | $58 - $727 | 54% |
| Wissahickon Hospice | $58 - $727 | 54% |
| Keystone Mercy Health Plan | $60 | 56% |
| Healthamerica/Coventry | $65 - $891 | 61% |
| Upmc | $69 - $1,818 | 65% |
| Olympus | $70 - $884 | 66% |
| First Health Global | $72 - $909 | 67% |
| Urn-Cancer Resource Services | $72 - $909 | 67% |
| Pa Medical Assistance | $76 | 71% |
| Health Net | $87 - $1,091 | 81% |
| Pgm - Royal Embassy Of Saudi Arabia | $87 - $1,091 | 81% |
| Pgm - Embassy Of Qatar | $94 - $1,182 | 88% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $94 - $1,182 | 88% |
| Blue Cross Blue Shield | $102 - $1,818 | 95% |
| Keystone Hmo Proactive | $102 | 95% |
| Pgm - Embassy Of The United Emirates/Ipc | $102 - $1,273 | 95% |
| Ibc Commercial Hpn | $106 | 99% |
| Medicare (plans) | $109 - $112 | 102% |
| Philadelphia Va Medical Center | $109 | 102% |
| Tricare | $110 | 103% |
| Ibc | $112 | 105% |
| Cigna | $113 - $205 | 106% |
| Geisinger Health Plan | $113 - $347 | 106% |
| Humana | $113 - $1,454 | 106% |
| Pa Health And Wellness | $115 - $180 | 108% |
| Penn Life (Living Independently For Elders) | $115 | 108% |
| Aetna | $116 - $1,818 | 109% |
| Devon Health Services Inc | $116 - $1,454 | 109% |
| Health America/Ccn | $116 - $1,454 | 109% |
| Intergroup | $116 - $1,454 | 109% |
| Pgm - Kuwait Health Division | $116 - $1,454 | 109% |
| Pgm - Kuwait Oil | $116 - $1,454 | 109% |
| Preferred Care | $116 - $1,454 | 109% |
| Clover Health Plan | $118 | 110% |
| Keystone First | $121 | 113% |
| Us Family Health Plan | $126 | 118% |
| Commercial Other | $145 - $1,818 | 136% |
| Community Behavioral Health | $145 - $1,818 | 136% |
| International Pfs | $145 - $1,818 | 136% |
| Quest Behavioral Health | $145 - $1,818 | 136% |
| United Behavioral Health | $145 - $1,818 | 136% |
| Workers Compensation | $145 - $1,818 | 136% |
| Elap | $155 | 145% |
| Claims Watcher | $175 - $197 | 164% |
| Oscar Health Plan | $186 | 174% |
| Centivo | $197 | 184% |
| Elap Services | $203 | 190% |
| Highmark | $230 | 215% |
| Penn Global Medicine | $290 | 272% |