CMS Price Transparency Data

Ultrasound, pelvis

Facility: Uva Health Culpeper Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $302
Cash Discount Price: $1,075
vs. Medicare Baseline: 2.83x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Uva Health Culpeper Medical Center is $302. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,075. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.83x the Medicare baseline. Located in 501 Sunset Lane, Culpeper, VA.

Cash / Self-Pay

$1,075

Average discount available for prompt cash payment at this facility.

Insurance Median

$302

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: $1,075 (1006%)

Insurance Median: $302 (283%)

Cash: $1,075 (1006% of Medicare)

Ins. Median: $302 (283% 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 283% of the Medicare baseline (a markup of 183%). 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
Tricare	$73 - $75	68%
Champva [50002]	$73 - $75	68%
Blue Ridge Pace [10510]	$94	88%
Medicaid / KanCare	$94	88%
VA Ccn [99926]	$105 - $108	98%
Medicare (plans)	$105 - $108	98%
Aetna	$105 - $1,507	98%
HMO Part B [10099]	$105	98%
Humana	$105 - $110	98%
Cigna	$105 - $890	98%
UnitedHealthcare	$105 - $1,232	98%
VA Ccn [99927]	$105 - $108	98%
Blue Cross Blue Shield	$105 - $313	98%
Veterans Administration [99910]	$108	101%
Carefirst [30007]	$237 - $288	222%
Sentara [40021]	$347 - $1,035	325%
Sentara Behavioral Health [40052]	$354 - $1,035	331%
Geha [40009]	$725 - $995	679%
Beacon Health Options [40012]	$856	801%
Commercial Contracted Hb Only [40056]	$899	842%
Commercial Generic [40000]	$899 - $1,199	842%
Multiplan Generic [40035]	$1,012 - $1,456	947%
Vhn Generic [40040]	$1,012 - $1,456	947%
Commercial Contracted Tpa [40055]	$1,028 - $1,199	962%
Umwa [40037]	$1,199	1123%
Kaiser Permenente [40014]	$1,199	1123%
Healthsmart [40013]	$1,285	1203%
First Health Generic [40033]	$1,405	1315%
Gateway Health Alliance [40034]	$1,456	1363%
Onenet Workers Comp Generic [60010]	$1,501	1405%

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 $1,075.
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 Uva Health Culpeper Medical Center 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.