CMS Price Transparency Data

Ultrasound, pelvis

Facility: Mainehealth Mid Coast Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $117
Cash Discount Price: $925
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Mainehealth Mid Coast Hospital is $117. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $925. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.10x the Medicare baseline. Located in 123 Medical Center Drive, Brunswick, ME.

Cash / Self-Pay

$925

Average discount available for prompt cash payment at this facility.

Insurance Median

$117

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: $925 (866%)

Insurance Median: $117 (110%)

Cash: $925 (866% of Medicare)

Ins. Median: $117 (110% 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	$31 - $371	29%
UnitedHealthcare	$31 - $873	29%
Aetna	$32 - $781	30%
Humana	$36 - $117	34%
Wellcare	$36 - $117	34%
Multiplan	$60 - $869	56%
Harvard Pilgrim Healthcare	$62 - $745	58%
Community Health Options	$66 - $870	62%
Cigna	$653 - $747	611%

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 $925.
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 Mainehealth Mid Coast 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.