CMS Price Transparency Data

Ultrasound, pelvis

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $133
Cash Discount Price: $1,254
vs. Medicare Baseline: 1.25x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at UMass Memorial Healthalliance Hospitals is $133. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,254. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.25x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$1,254

Average discount available for prompt cash payment at this facility.

Insurance Median

$133

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: $1,254 (1174%)

Insurance Median: $133 (125%)

Cash: $1,254 (1174% of Medicare)

Ins. Median: $133 (125% 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.

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
Workers Compensation [20501]	$97	91%
Champva [11001]	$114	107%
Institution [10406]	$125 - $377	117%
Medicare (plans)	$125 - $127	117%
Tufts Dual [10111]	$125 - $127	117%
Cigna	$127 - $601	119%
Correctional Care [11003]	$127	119%
Medicaid / KanCare	$127 - $370	119%
Tufts Us Family [11203]	$127	119%
Blue Cross Blue Shield	$129 - $207	121%
Aetna	$132 - $133	124%
Commonwealth Care Mcr [10115]	$132 - $133	124%
Fallon Mcr Supp [20202]	$132 - $133	124%
Mgb Mcr [10124]	$132 - $133	124%
Tufts Mcr [10112]	$132 - $133	124%
Harvard Pilgrim Mcr [10106]	$133	125%
UnitedHealthcare	$133 - $712	125%
Senior Whole Health [10110]	$136	127%
Wellpoint [11112]	$198	185%
Tufts Connectorcare [10507]	$213 - $216	199%
Tufts [11201]	$282 - $520	264%
Hsno/Free Care [10801]	$294	275%
Hne [11108]	$397	372%
Harvard Pilgrim [10701]	$480 - $576	449%
First Health Network [11120]	$534	500%
Multiplan [11109]	$534	500%
Connecticare [11105]	$712	667%
Fallon Carelon Hlth [28]	$712	667%
Fallon Mcaid Carelon Hlth [29]	$712	667%
Grants [20507]	$712	667%

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 $1,254.
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 UMass Memorial Healthalliance Hospitals 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.