CMS Price Transparency Data

Ultrasound, pelvis

Facility: Kings County Hospital Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $179
Cash Discount Price: $126
vs. Medicare Baseline: 1.68x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Kings County Hospital Center is $179. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $126. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.68x the Medicare baseline. Located in 451 Clarkson Avenue, Brooklyn, NY.

Cash / Self-Pay

$126

Average discount available for prompt cash payment at this facility.

Insurance Median

$179

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: $126 (118%)

Insurance Median: $179 (168%)

Cash: $126 (118% of Medicare)

Ins. Median: $179 (168% 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
Aetna	$26 - $1,131	24%
Healthfirst	$28 - $1,783	26%
Amidacare	$35 - $793	33%
Emblem	$35 - $1,070	33%
Wellcare	$38 - $130	36%
Metroplus	$45 - $1,783	42%
Fidelis	$51 - $1,783	48%
Oscar	$53 - $189	50%
United	$55 - $1,221	51%
Blue Cross Blue Shield	$97 - $1,783	91%
Affinity	$106 - $1,783	99%
Centerlight	$120 - $763	112%
Elderplan	$120 - $992	112%
Local 1199	$123 - $1,297	115%
Centers Plan For Healthy Living	$125 - $131	117%
Hamaspik	$126	118%
Vaccn	$126	118%
Vnsny	$126 - $1,297	118%
Oxford	$147 - $915	138%
Cigna	$177 - $1,144	166%
Carelon	$793 - $992	742%
Senior Whole Health	$793	742%
United Behavioral Health	$793 - $872	742%
Carelon (Amida Care)	$808	756%
Magnacare	$1,144	1071%
Multiplan	$1,221	1143%
Villagecare Max	$1,297	1214%

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 $126.
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 Kings County Hospital 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.