CMS Price Transparency Data

Ultrasound, pelvis

Facility: El Centro Regional Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $821
Cash Discount Price: $1,025
vs. Medicare Baseline: 7.69x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at El Centro Regional Medical Center is $821. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,025. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.69x the Medicare baseline. Located in 1415 Ross Avenue, El Centro, CA.

Cash / Self-Pay

$1,025

Average discount available for prompt cash payment at this facility.

Insurance Median

$821

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: $1,025 (960%)

Insurance Median: $821 (769%)

Cash: $1,025 (960% of Medicare)

Ins. Median: $821 (769% 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 769% of the Medicare baseline (a markup of 669%). 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
Blue Cross Blue Shield	$134 - $1,464	125%
Brand New Day Comm - All Other Plans	$134	125%
Brand New Day Mcr	$134	125%
Healthnet Mcr Adv	$134	125%
Molina Mcr Adv	$134	125%
Scp Managed Care - All Plans	$134	125%
Tricare	$134	125%
UnitedHealthcare	$134 - $734	125%
Easy Choice Mcr Adv-All Plans	$148	139%
Blue Shield-All Plans	$149	140%
Healthnet Hmo	$168	157%
Cdcr Correctional-All Plans	$174	163%
Aetna	$644	603%
Pacificare-All Plans	$908	850%
Mulitplan Primary - All Other Plans	$996	932%
Cigna	$1,098	1028%
Multiplan Comp	$1,171	1096%
Trident - All Plans	$1,244	1165%
Healthnet Comm-All Other Plans	$1,318	1234%
Humana	$1,362	1275%
Ahccs/Medi-Cal Misc - All Plans	$1,464	1371%
Brand New Day Mcal	$1,464	1371%
Medi-Cal	$1,464	1371%
Molina Exchange - All Other Plans	$1,464	1371%
Ambetter / Centene	$1,508	1412%
Molina Mcal	$1,610	1507%

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 $1,025.
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 El Centro Regional Medical Center 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.