CMS Price Transparency Data

Ultrasound, pelvis

Facility: New London Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $99
Cash Discount Price: $399
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at New London Hospital is $99. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $399. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.93x the Medicare baseline. Located in 273 County Road, New London, NH.

Cash / Self-Pay

$399

Average discount available for prompt cash payment at this facility.

Insurance Median

$99

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: $399 (374%)

Insurance Median: $99 (93%)

Cash: $399 (374% of Medicare)

Ins. Median: $99 (93% 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	$32 - $740	30%
Martin'S Point Generations Advantage	$32 - $384	30%
Martin'S Point Health Care	$32 - $600	30%
UnitedHealthcare	$32 - $683	30%
Wellcare Health Plans	$32 - $384	30%
Amerihealth Caritas Nh	$33 - $445	31%
Granite State Health Plan	$33 - $441	31%
Wellsense Health Plan	$33 - $384	31%
Aetna	$36 - $754	34%
Harvard Pilgrim Health Care Of Ne	$37 - $623	35%
Ambetter / Centene	$41 - $384	38%
Cigna	$43 - $591	40%
Tufts Health Plan	$604 - $628	565%
Coventry	$825	772%
Multiplan	$829	776%

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 $399.
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 New London 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.