Ultrasound Pelvis Cost
Us exam pelvic complete
$139Hospital outpatient total2026 Medicare, physician + facilityUnder 2026 Medicare rates, an ultrasound pelvis costs up to about $139 in total at a hospital outpatient department, counting both the physician and the facility. Outside a hospital, one global fee of about $105 covers the whole test, and a ZIP code adjusts every figure to your area.
- ✓Your ZIP's wage-adjusted hospital and surgery center rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
National Medicare physician rate (2026)
What the whole procedure costs
The office rate above is what an imaging center, lab or office is paid for the whole test. In a hospital, the facility bills its own fee and the physician bills only the reading. These are 2026 national Medicare amounts.
Medicare may pay the facility separately for this code or package it into another service on the same day, so treat the facility share as an upper bound. For a test like this the physician in a hospital bills only the reading (the professional component); outside a hospital one global fee covers the whole test, shown in the office rate above. Medicare allowed amounts are not what an uninsured patient is charged, and not a quote. Private plans typically allow more.
Get the rate for your ZIP
CMS adjusts this CPT by locality. A five-digit ZIP is enough: no account, no insurance card.
What ultrasound pelvis costs at hospitals near you
Everything above is a national average. The hospital you pick in your area moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
For example 90001.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery center rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again. For this code the office and hospital physician lines differ by $72.81.
How CMS prices CPT 76856
Work is about 21% of the office total RVU; practice expense is about 77%. Localities with a high PE GPCI move this code more when practice expense is a large share.
Office vs hospital for this code
Office (non-facility) physician rate: $105.21. Hospital (facility) physician rate: $32.40.
Medicare patients typically owe 20% of the allowed amount after the Part B deductible, about $21 for the office physician fee, before any Medigap coverage. That coinsurance does not include a hospital facility fee.
Labeled private-plan and cash ranges on this page are arithmetic multiples of Medicare, not negotiated quotes. Ask the billing office for the CPT code, the site of service, and a good-faith estimate.
Ultrasound Pelvis cost by state
2026 Medicare non-hospital rate for CPT 76856, averaged across each state's localities. Open a state for its locality table and full cost breakdown.
What Is Ultrasound Pelvis?
A complete pelvic ultrasound scans the bladder, uterus, and ovaries through the lower abdomen using a probe on the skin, requiring a full bladder to push bowel out of the way and create a clear acoustic window. It evaluates pelvic pain, fibroids, and masses, and in males or by protocol it examines the bladder and surrounding structures. The exam takes 15 to 30 minutes; the full-bladder requirement is most patients' only complaint.
What Affects the Cost
- –It is commonly paired with a transvaginal study (76830) in one appointment, producing two billed exams.
- –Hospital imaging departments price this study well above independent centers and office-based machines.
- –An inadequately filled bladder can force rebooking, effectively costing a second visit.
- –A limited pelvic ultrasound is a cheaper code when only one structure needs a follow-up look.
- –Separate professional reading fees apply where radiologists interpret off-site.
How It Is Billed
CPT 76856 requires a complete evaluation of the pelvic organs; follow-up of a single known finding should bill as the limited study 76857 at a lower rate. When transabdominal and transvaginal exams are both performed with documented need, both codes appear on the same claim. Obstetric indications shift billing to pregnancy ultrasound codes entirely, which have their own frequency and coverage rules.
Insurance & Coverage Notes
This ultrasound is covered as diagnostic imaging without prior authorization on nearly all plans, at standard deductible or copay levels. It is not part of any routine screening benefit; there is no recommended screening pelvic ultrasound for average-risk women, so a claim without symptoms or findings behind it can be denied as not medically necessary. Confirm the order lists your symptoms or the finding being followed.
Questions to Ask Before Booking
- 1.Is a complete study needed, or is this a follow-up that qualifies for the cheaper limited code?
- 2.Will a transvaginal exam likely be added during the visit, and what would both together cost?
- 3.What are the bladder-filling instructions so I am not rebooked?
- 4.What is the price difference between your office, an imaging center, and the hospital?
- 5.What diagnosis is on the order to support coverage?
Ultrasound Pelvis (CPT 76856): questions
Under 2026 Medicare rates, an ultrasound pelvis costs up to about $139 in total at a hospital outpatient department, counting both the physician and the facility. Outside a hospital, one global fee of about $105 covers the whole test, and a ZIP code adjusts every figure to your area.
Outside a hospital, one global fee pays for the equipment, the staff and the doctor's reading, so the office or imaging center rate for CPT 76856 is $105.21. In a hospital the physician bills only the reading, about $32.40, and the hospital is paid for the rest on its own claim.
A complete pelvic ultrasound scans the bladder, uterus, and ovaries through the lower abdomen using a probe on the skin, requiring a full bladder to push bowel out of the way and create a clear acoustic window. It evaluates pelvic pain, fibroids, and masses, and in males or by protocol it examines the bladder and surrounding structures. The exam takes 15 to 30 minutes; the full-bladder requirement is most patients' only complaint. CMS bills it as “Us exam pelvic complete.”
It depends on the setting. At an independent imaging center, lab or office, $105.21 is Medicare's full national rate, covering the test and the reading. In a hospital outpatient department the physician is paid only for the reading (about $32.40) and the hospital is paid separately, which takes the total to about $139. Private-plan allowed amounts are often higher than Medicare; your deductible and coinsurance still apply.
For cash-pay surgery shopping, use this CPT as the Medicare floor when you compare written quotes. How cash-price shopping works.