CMS Price Transparency Data

Ultrasound, pelvis

Facility: Harlem Hospital Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $763
Cash Discount Price: Unavailable
vs. Medicare Baseline: 7.14x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Harlem Hospital Center is $763. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.14x the Medicare baseline. Located in 506 Lenox Avenue, New York, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$763

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%)

Insurance Median: $763 (714%)

Ins. Median: $763 (714% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 714% of the Medicare baseline (a markup of 614%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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 - $1,774	26%
Amidacare	$35 - $788	33%
Emblem	$35 - $1,064	33%
Wellcare	$38 - $126	36%
Metroplus	$45 - $1,774	42%
Fidelis	$50 - $1,774	47%
Oscar	$52 - $189	49%
United	$55 - $1,221	51%
Blue Cross Blue Shield	$126 - $1,774	118%
Vaccn	$126	118%
Vnsny	$126 - $1,297	118%
Centers Plan For Healthy Living	$131	123%
Oxford	$147 - $915	138%
Cigna	$177 - $1,144	166%
Elderplan	$252 - $992	236%
Centerlight	$763	714%
Carelon	$788 - $992	738%
Senior Whole Health	$788	738%
United Behavioral Health	$788 - $867	738%
Affinity	$804 - $1,774	753%
Carelon (Amida Care)	$804	753%
Magnacare	$1,144	1071%
Multiplan	$1,221	1143%
Local 1199	$1,297	1214%
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 $X.
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 Harlem 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.