CPT76856

Ultrasound Pelvis Cost in New Jersey

Us exam pelvic complete

$212Hospital outpatient total2026 Medicare, physician + facility
Hospital payments are wage-adjusted by locality, so the ZIP changes the numbers.
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New Jersey Medicare physician rate (2026)

+10.9% vs national

Average of 2 localities. Office range $113.74–$119.72.

New Jersey (Hospital)
$116.73
Facility physician fee
Private plan est.
$152–$233
~130–200% of Medicare
Cash / self-pay est.
$93–$175
~80–150% of Medicare

What the whole procedure costs

The rate above is the physician’s fee on its own. The facility bills separately, and for most procedures the facility is the larger half of the bill. These are 2026 national Medicare amounts.

Surgery centre, total
$162
$105 physician + $57 facility
Physician fee alone
$105
Only 50% of the hospital total

Choosing a surgery centre over a hospital saves about $50 on the Medicare allowed amount for ultrasound pelvis. Ask whether your procedure can be done at an ambulatory surgery centre.

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. Medicare allowed amounts are not what an uninsured patient is charged, and not a quote. Private plans typically allow more.

Your ZIP in New Jersey

Look up your ZIP code to see whether northern or rest-of-state New Jersey pricing applies, from Newark, Jersey City, and Bergen County down to Trenton, Cherry Hill, and the Jersey Shore.

What ultrasound pelvis costs at hospitals near you

Everything above is a national average. The hospital you pick in New Jersey moves the bill more than anything else you control.

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Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.

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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 centre 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.

National vs New Jersey

National office$105.21
National hospital (physician)$105.21
New Jersey vs national11% above the national office rate of $105.21

Where New Jersey ranks for this CPT

Rank (lowest physician fee first)#47 of 51
Lowest stateArkansas ($92.96)
Highest stateDistrict of Columbia ($121.06)

CPT 76856 by New Jersey locality

LocalityOffice
northern nj$119.72
rest of new jersey$113.74

PE GPCI ranges from 1.092 to 1.160 in New Jersey. That index is why the same CPT is not one price statewide.

Ultrasound Pelvis and how New Jersey is priced

New Jersey is split into two payment localities: northern New Jersey, which carries higher adjustments befitting its position in the New York metropolitan orbit, and the rest of the state to the south. Both localities price above the national average, but the northern one ranks among the more expensive in the country. The dividing line means a procedure in Bergen County is approved at a higher amount than the same one in Cherry Hill or along the shore. South Jersey's pricing gravity pulls toward Philadelphia even though its locality is its own.

New Jersey may be the ultimate cross-border care state: North Jersey residents flow into Manhattan hospitals, South Jersey residents into Philadelphia's academic centers, and the state's own large systems compete hard in between. Dense population means most residents have multiple hospitals within a short drive, which is real negotiating leverage for a cash-pay patient. The shore counties see seasonal population surges that strain capacity each summer.

This procedure: 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 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.

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 in New Jersey: questions

The 2026 Medicare physician office rate for CPT 76856 averages $116.73 across 2 New Jersey localities, from $113.74 in REST OF NEW JERSEY to $119.72 in NORTHERN NJ. The hospital physician rate averages $116.73. Enter a ZIP for the exact locality.

Yes. CMS splits New Jersey into 2 payment localities. For this CPT the office physician fee spans $5.98 from the lowest to highest locality. Look up your ZIP code to see whether northern or rest-of-state New Jersey pricing applies, from Newark, Jersey City, and Bergen County down to Trenton, Cherry Hill, and the Jersey Shore.

After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $23 for the office physician line or $23 for the hospital physician line in New Jersey. Medigap may cover that 20%. This is not the hospital facility fee.

No. $116.73 is only the physician's share. Adding Medicare's facility payment brings the total to about $212 in a hospital outpatient department, or about $162 at an ambulatory surgery centre. Anesthesia, pathology and other codes billed the same day are extra. New Jersey ranks #47 of 51 states on the physician line (11% above the national office rate of $105.21).

Data source: 2026 Medicare Physician Fee Schedule (CMS PPRRVU26B, released March 2026). Conversion factor: $33.4009. Prices shown are Medicare allowed amounts for the physician service and may not match what you are billed. Private insurance and self-pay ranges, when shown, are labeled estimates (typical multiples of Medicare), not quotes. This site is an independent cost tool, not medical advice.