CMS Price Transparency Data

Ultrasound, pelvis

Facility: Boston Children's Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $667
Cash Discount Price: $940
vs. Medicare Baseline: 6.24x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Boston Children's Hospital is $667. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $940. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.24x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$940

Average discount available for prompt cash payment at this facility.

Insurance Median

$667

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: $940 (880%)

Insurance Median: $667 (624%)

Cash: $940 (880% of Medicare)

Ins. Median: $667 (624% 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 624% of the Medicare baseline (a markup of 524%). 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	$232 - $621	217%
Unicare	$299	280%
Cdphp	$461 - $799	432%
Harvard Pilgrim	$478 - $635	448%
United	$562 - $785	526%
Aetna	$564 - $788	528%
Mgb/Allways	$572 - $695	536%
Tufts Public Plan	$577 - $579	540%
United Ri Nj Ny	$592	554%
Ambetter / Centene	$594	556%
Carelon Strategies/Bhs	$611	572%
UnitedHealthcare	$611 - $799	572%
Carelon/Beacon	$705	660%
Fallon	$717 - $725	671%
Health New England	$760	712%
Cigna	$799 - $848	748%
Ets/Lifetrac	$799	748%
Interlink Transplant	$799	748%
Community Health Options	$846	792%
Humana	$846	792%
Coventry/Hcvm/First Health	$865	810%
Multiplan/Phcs	$865 - $893	810%

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 $940.
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 Boston Children's 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.