CMS Price Transparency Data

Ultrasound, pelvis

Facility: Down East Community Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $427
Cash Discount Price: $385
vs. Medicare Baseline: 4.00x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Down East Community Hospital is $427. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $385. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.00x the Medicare baseline. Located in 11 Hospital Drive, Machias, ME.

Cash / Self-Pay

$385

Average discount available for prompt cash payment at this facility.

Insurance Median

$427

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: $385 (360%)

Insurance Median: $427 (400%)

Cash: $385 (360% of Medicare)

Ins. Median: $427 (400% 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 400% of the Medicare baseline (a markup of 300%). 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	$111 - $884	104%
Humana	$111 - $482	104%
Wellcare	$111 - $482	104%
Partners Direct Health	$126 - $548	118%
Community Health Options	$209 - $907	196%
Aetna	$210 - $915	197%
UnitedHealthcare	$217 - $943	203%
Cigna	$227 - $989	213%
Martins Point	$227 - $986	213%
Patients Advocates	$227 - $986	213%
Harvard Pilgrim	$231 - $1,003	216%

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 $385.
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 Down East Community 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.