CMS Price Transparency Data

Ultrasound, pelvis

Facility: St Clair Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $123
Cash Discount Price: $136
vs. Medicare Baseline: 1.15x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at St Clair Hospital is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $136. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.15x the Medicare baseline. Located in 1000 Bower Hill Road, Pittsburgh, PA.

Cash / Self-Pay

$136

Average discount available for prompt cash payment at this facility.

Insurance Median

$123

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: $136 (127%)

Insurance Median: $123 (115%)

Cash: $136 (127% of Medicare)

Ins. Median: $123 (115% 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
Upmc	$60 - $219	56%
UnitedHealthcare	$80 - $334	75%
Aetna	$88 - $273	82%
Amerihealth	$88 - $102	82%
Geisinger	$88 - $105	82%
Health Partners	$88 - $107	82%
Highmark	$88 - $228	82%
Pa Health And Wellness	$88 - $106	82%
Humana	$102	95%
Cigna	$106 - $123	99%
The Health Plan	$107 - $244	100%
Lantern	$219	205%

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 $136.
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 St Clair 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.