CMS Price Transparency Data

Ultrasound, pelvis

Facility: Emerson Hospital -

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $199
Cash Discount Price: $773
vs. Medicare Baseline: 1.86x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Emerson Hospital - is $199. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $773. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.86x the Medicare baseline. Located in 133 Old Road To 9 Acre Corner, W Concord, MA.

Cash / Self-Pay

$773

Average discount available for prompt cash payment at this facility.

Insurance Median

$199

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: $773 (724%)

Insurance Median: $199 (186%)

Cash: $773 (724% of Medicare)

Ins. Median: $199 (186% 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
Blue Cross Blue Shield	$123 - $199	115%
Medicare (plans)	$123 - $126	115%
Tufts Senior Care Options	$123	115%
UnitedHealthcare	$123 - $1,030	115%
Medicaid / KanCare	$125	117%
Wellpoint (Formerly Unicare)	$144	135%
Masshealth	$199	186%
Mgb Mh Aco	$199	186%
Tufts Ppo	$379	355%
Aetna	$659	617%
Cigna	$942	882%

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 $773.
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 Emerson Hospital - 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.