CMS Price Transparency Data

Ultrasound, pelvis

Facility: Mary Hitchcock Memorial Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $190
Cash Discount Price: $292
vs. Medicare Baseline: 1.78x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Mary Hitchcock Memorial Hospital is $190. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $292. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.78x the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.

Cash / Self-Pay

$292

Average discount available for prompt cash payment at this facility.

Insurance Median

$190

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: $292 (273%)

Insurance Median: $190 (178%)

Cash: $292 (273% of Medicare)

Ins. Median: $190 (178% 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
Wellsense Health Plan	$24 - $158	22%
Aetna	$32 - $911	30%
Beacon Health Strategies/Carelon	$32 - $158	30%
Blue Cross Blue Shield	$32 - $1,131	30%
Cigna	$32 - $890	30%
Martin'S Point Generations Advantage	$32 - $119	30%
Martin'S Point Health Care	$32 - $448	30%
Mvp	$32 - $870	30%
UnitedHealthcare	$32 - $997	30%
Ambetter / Centene	$33 - $256	31%
Amerihealth Caritas Nh	$33 - $147	31%
Granite State Health Plan	$33 - $163	31%
Wellcare Health Plans	$33 - $124	31%
Harvard Pilgrim Health Care Of Ne	$40 - $833	37%
Mass General Brigham Health Plan	$91 - $807	85%
Tufts Health Plan	$106 - $757	99%
Maine Community Health Options	$389 - $954	364%
Coventry	$532 - $1,129	498%
First Health/Hcvm	$532 - $1,129	498%
Phcs	$550 - $1,168	515%
Corvel	$562 - $1,194	526%
Ccmsi	$580 - $1,233	543%

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 $292.
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 Mary Hitchcock Memorial 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.