CMS Price Transparency Data

Ultrasound, pelvis

Facility: Maimonides Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $35
Cash Discount Price: $305
vs. Medicare Baseline: 0.33x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Maimonides Medical Center is $35. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $305. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.33x the Medicare baseline. Located in 4802 Tenth Avenue, Brooklyn, NY.

Cash / Self-Pay

$305

Average discount available for prompt cash payment at this facility.

Insurance Median

$35

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: $305 (286%)

Insurance Median: $35 (33%)

Cash: $305 (286% of Medicare)

Ins. Median: $35 (33% 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	$14 - $327	13%
Healthfirst	$14 - $132	13%
Elderplan	$15 - $35	14%
United Community Plan	$15 - $144	14%
UnitedHealthcare	$15 - $172	14%
Fidelis	$16 - $102	15%
Aetna	$21 - $170	20%
Oxford Health Plan	$22 - $172	21%
Healthfirst Early Start	$27 - $29	25%
Metroplus	$27 - $157	25%
Emblem Health - Hip	$29 - $97	27%
Visiting Nurse Svc Of Ny	$29 - $34	27%
Cigna	$30 - $185	28%
Wellcare	$33 - $35	31%
Emblem Health - Hip Vip	$35	33%
Molina	$35 - $218	33%
Local 1199	$39 - $123	37%
Oxford Liberty	$46 - $172	43%
Emblem Health - Ghi	$55 - $397	51%

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 $305.
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 Maimonides 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.