CMS Price Transparency Data

Ultrasound, pelvis

Facility: Stafford Hospital, LLC

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $231
Cash Discount Price: $297
vs. Medicare Baseline: 2.16x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Stafford Hospital, LLC is $231. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $297. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.16x the Medicare baseline. Located in 101 Hospital Center Boulevard, Stafford, VA.

Cash / Self-Pay

$297

Average discount available for prompt cash payment at this facility.

Insurance Median

$231

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: $297 (278%)

Insurance Median: $231 (216%)

Cash: $297 (278% of Medicare)

Ins. Median: $231 (216% 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 216% of the Medicare baseline (a markup of 116%). 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
Humana	$105 - $228	98%
Molina	$109 - $237	102%
Kaiser	$112 - $244	105%
Blue Cross Blue Shield	$173 - $237	162%
UnitedHealthcare	$180 - $228	169%
Innovation	$211 - $233	198%
Aetna	$228 - $426	213%
Sentara	$228 - $267	213%
Cf	$265 - $288	248%
Cigna	$351 - $439	329%
Medcost	$354	331%
PHCS	$362	339%

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 $297.
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 Stafford Hospital, LLC 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.