CMS Price Transparency Data

Ultrasound, pelvis

Facility: City of Hope National Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $852
Cash Discount Price: $1,140
vs. Medicare Baseline: 7.98x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at City of Hope National Medical Center is $852. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,140. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.98x the Medicare baseline. Located in 1500 Duarte Rd, Duarte, CA.

Cash / Self-Pay

$1,140

Average discount available for prompt cash payment at this facility.

Insurance Median

$852

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: $1,140 (1067%)

Insurance Median: $852 (798%)

Cash: $1,140 (1067% of Medicare)

Ins. Median: $852 (798% 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 798% of the Medicare baseline (a markup of 698%). 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
Health Net	$47 - $1,178	44%
Cal Optima	$66 - $95	62%
Heritage Provider Network	$85 - $850	80%
Inland Empire	$102 - $972	95%
Prime Healthcare Keenan	$146 - $1,166	137%
Blue Cross Blue Shield	$439 - $850	411%
UnitedHealthcare	$539 - $680	505%
Cigna	$573	536%
Blue Shield	$630 - $1,448	590%
Blue Shield Covca	$647 - $738	606%
Blue Shield Promise	$745 - $850	698%
Cencal	$852 - $972	798%
La Care Health	$852 - $972	798%
Kaiser	$958 - $1,093	897%
Gold Coast	$1,064 - $1,214	996%
Molina	$1,064 - $1,579	996%
Facey	$1,171 - $1,336	1096%
Healthcare Partners	$1,235 - $1,409	1156%
St. Joseph Heritage	$1,277 - $1,457	1196%
Primecare Medical Network	$1,384 - $1,579	1296%
First Health	$1,639 - $1,870	1535%
Phcs Multiplan	$1,916 - $2,186	1794%

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 $1,140.
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 City of Hope National 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.