CMS Price Transparency Data

Ultrasound, pelvis

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $1,050
Cash Discount Price: $715
vs. Medicare Baseline: 9.83x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Carilion Stonewall Jackson Hospital is $1,050. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $715. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.83x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.

Cash / Self-Pay

$715

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,050

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: $715 (669%)

Insurance Median: $1,050 (983%)

Cash: $715 (669% of Medicare)

Ins. Median: $1,050 (983% 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 983% of the Medicare baseline (a markup of 883%). 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
Aetna	$92 - $1,357	86%
Humana	$94 - $111	88%
Blue Cross Blue Shield	$100 - $488	94%
UnitedHealthcare	$101 - $1,671	95%
Sentara Health Plan	$103 - $1,267	96%
Abh of VA (Formerly Coventry)	$111	104%
Abh of Wva (Formerly Coventry)	$111	104%
Gateway - Tier 3	$1,124	1052%
Vhn - Ultra	$1,267	1186%
Connecticare	$1,431	1340%
Gateway - Tier 2	$1,635	1531%
Vhn - Plus	$1,635	1531%
Cigna	$1,637	1533%
Integrated Health Plan	$1,737	1626%
Vhn	$1,737	1626%
Vhn - Link	$1,840	1723%
Beech Street	$1,880	1760%
Vhn - Secondary Payors	$1,942	1818%
Gateway - Tier 1	$1,942	1818%

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 $715.
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 Carilion Stonewall Jackson 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.