CMS Price Transparency Data

Ultrasound, pelvis

Facility: Carolina East Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $290
Cash Discount Price: $478
vs. Medicare Baseline: 2.72x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Carolina East Medical Center is $290. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $478. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.72x the Medicare baseline. Located in 2000 Neuse Blvd, New Bern, NC.

Cash / Self-Pay

$478

Average discount available for prompt cash payment at this facility.

Insurance Median

$290

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: $478 (448%)

Insurance Median: $290 (272%)

Cash: $478 (448% of Medicare)

Ins. Median: $290 (272% 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 272% of the Medicare baseline (a markup of 172%). 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
Humana	$31 - $100	29%
Inclusive Health (Nchirp)-All Plans	$31 - $100	29%
Tricare	$31 - $1,273	29%
Pamlico Co Jail-All Plans	$85 - $339	80%
UnitedHealthcare	$112 - $905	105%
Craven Co. Jail Systems - All Plans	$187 - $429	175%
Medcost Ppo Employees And Retirees	$211 - $836	198%
Medcost Ppo Ultra (Employees)	$211 - $796	198%
Blue Cross Blue Shield	$224 - $873	210%
Medcost Ppo City Employees	$234 - $927	219%
Medcost Ppo County Employee	$243 - $964	228%
Benefit Mgmt, Svcs-All Plans	$273 - $1,082	256%
Aetna	$284 - $1,128	266%
Medcost Benefit Svc-All Other Plans	$284 - $1,125	266%
Acs Consult Svc Inc-All Plans	$290 - $1,150	272%
Medcost Ppo Standard	$290 - $1,150	272%
Cigna	$292 - $1,158	273%

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 $478.
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 Carolina East Medical Center 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.