CMS Price Transparency Data

Ultrasound, pelvis

Facility: Porter Hospital Inc

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $116
Cash Discount Price: $170
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Porter Hospital Inc is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $170. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.09x the Medicare baseline. Located in 115 Porter Drive, Middlebury, VT.

Cash / Self-Pay

$170

Average discount available for prompt cash payment at this facility.

Insurance Median

$116

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: $170 (159%)

Insurance Median: $116 (109%)

Cash: $170 (159% of Medicare)

Ins. Median: $116 (109% 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
UnitedHealthcare	$21 - $669	20%
Mvp	$26 - $630	24%
Fidelis Care	$28 - $286	26%
Humana	$29 - $101	27%
Aetna	$31 - $318	29%
Capital District Physicians' Health Plan	$31 - $564	29%
Martins Point	$31 - $318	29%
Veterans Affairs Community Care Network	$31 - $318	29%
Veterans Choice	$31 - $318	29%
Blue Cross Blue Shield	$35 - $637	33%
Harvard Pilgrim	$36 - $541	34%
Coventry	$40 - $595	37%
Cigna	$46 - $615	43%
Wellpath	$94 - $372	88%
Medical Corporation	$162 - $642	152%
Multiplan	$162 - $642	152%

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 $170.
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 Porter Hospital Inc 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.