CMS Price Transparency Data

Ultrasound, pelvis

Facility: Children's Hospital of Philadelphia

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $988
Cash Discount Price: $2,953
vs. Medicare Baseline: 9.25x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Children's Hospital of Philadelphia is $988. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,953. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.25x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$2,953

Average discount available for prompt cash payment at this facility.

Insurance Median

$988

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: $2,953 (2765%)

Insurance Median: $988 (925%)

Cash: $2,953 (2765% of Medicare)

Ins. Median: $988 (925% 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 925% of the Medicare baseline (a markup of 825%). 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
Geisinger Medical Assistance	$63	59%
Highmark Wholecare	$70	66%
Horizon Nj Health	$238	223%
UnitedHealthcare	$430 - $490	403%
Medicaid / KanCare	$487	456%
Health Partners	$557	521%
Aetna	$777 - $1,476	727%
Upmc Medical Assistance	$806	755%
Geisinger Health Plan Commercial	$869	814%
Keystone First Chip	$915	857%
Keystone Health Plan East	$934	874%
Blue Cross Blue Shield	$1,042 - $1,183	976%
Jefferson Health Plans	$1,397	1308%
Cigna	$1,476	1382%
Highmark	$1,476	1382%
Qualcare	$1,624	1520%
First Health Network	$1,919	1797%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$2,362	2211%
Private Health Care Systems	$2,362	2211%
Choice Care Network	$2,658	2489%

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 $2,953.
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 Children's Hospital of Philadelphia 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.