CMS Price Transparency Data

Ultrasound, pelvis

Facility: Montefiore Mount Vernon Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $131
Cash Discount Price: $892
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Montefiore Mount Vernon Hospital is $131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $892. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.23x the Medicare baseline. Located in 12 North 7Th Avenue, Mount Vernon, NY.

Cash / Self-Pay

$892

Average discount available for prompt cash payment at this facility.

Insurance Median

$131

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: $892 (835%)

Insurance Median: $131 (123%)

Cash: $892 (835% of Medicare)

Ins. Median: $131 (123% 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
Emblem	$56 - $1,098	52%
Fidelis	$56 - $130	52%
Healthfirst	$56 - $130	52%
Medicaid / KanCare	$56	52%
Wellcare	$56 - $133	52%
Vnsny Choice	$64 - $130	60%
Vnsny Select Health	$64	60%
Metroplus	$118 - $170	110%
Blue Cross Blue Shield	$130 - $1,098	122%
Point Comfort	$130	122%
UnitedHealthcare	$130 - $245	122%
Villagecaremax	$130	122%
Centerlight	$134 - $144	125%
Elderplan	$134	125%
Partners Health Plan	$137	128%
Longevity	$142	133%
Humana	$144	135%
Molina Healthcare Of Ny Affinity	$180	169%
Oscar	$206	193%
American Postal Workers	$245	229%
Mvp	$266	249%
Aetna	$347 - $388	325%
Northwell	$351	329%
Cigna	$731 - $812	684%

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 $892.
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 Montefiore Mount Vernon 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.