CMS Price Transparency Data

Ultrasound, pelvis

Facility: Loma Linda University Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $525
Cash Discount Price: $1,180
vs. Medicare Baseline: 4.92x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Loma Linda University Medical Center is $525. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,180. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.92x the Medicare baseline. Located in 11234 Anderson St, Loma Linda, CA.

Cash / Self-Pay

$1,180

Average discount available for prompt cash payment at this facility.

Insurance Median

$525

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: $1,180 (1105%)

Insurance Median: $525 (492%)

Cash: $1,180 (1105% of Medicare)

Ins. Median: $525 (492% 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 492% of the Medicare baseline (a markup of 392%). 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
Inland Empire Health Plan (Iehp)	$116 - $135	109%
Kaiser Foundation Hospitals	$129 - $1,750	121%
Adventist Health	$135 - $525	126%
Alpha Care Medical Group	$135 - $203	126%
Dignity Health	$135 - $203	126%
Epic Health Plan	$135 - $1,049	126%
UnitedHealthcare	$135 - $247	126%
Upland Medical Group	$135	126%
Vantage Medical Group	$135 - $203	126%
Prime Health Services	$143 - $2,230	134%
Riverside University Health System	$149	140%
Molina Healthcare Of Ca	$181	169%
Heritage Provider Network	$222	208%
Blue Cross Blue Shield	$319 - $1,540	299%
Lluh Dept Of Risk Management	$525	492%
Blue Shield Of California	$1,041 - $1,592	975%
Global Benefits Group	$1,574	1474%
Temecula Valley Physicians Medical Group	$1,574	1474%
Trivalley Medical Group	$1,574	1474%
Aetna	$1,593	1491%
Cigna	$1,679 - $1,941	1572%
Networks By Design	$1,705	1596%
Multiplan	$1,967	1842%
Central Health Plan	$2,098	1964%
Galaxy Health	$2,230	2088%
Health Management Network	$2,361	2210%

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 $1,180.
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 Loma Linda University 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.