CMS Price Transparency Data

Ultrasound, pelvis

Facility: Good Samaritan Hospital Medical Center

Billing Code: 76856 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$137

about 1.3× the $107 Medicare rate · typically $100–$256

modeled estimate · not a bill or quote

What this hospital charges insurers

$126

About the fair price

about $11 under the fair price · 1.2× Medicare

Medicare pays $107 Fair price $137 This hospital $126 Hospital's list price $1,693

How we calculate the fair BaseRate →

How this hospital compares to other NY hospitals

Highest price of the 9 NY hospitals we have prices for — worth calling around.

Cheapest $35 Priciest $126

Black dot = this hospital, among the 9 NY hospitals with a price for this procedure. Full list below.

A fair price for a Ultrasound, pelvis is about $137 (about 1.3× the $107 Medicare rate). Good Samaritan Hospital Medical Center charges insurers about $126 — about the fair price. Located in West Islip, NY.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$56 - $1,100	52%
Blue Cross Blue Shieldmajor	$123 - $281	115%
Aetnamajor	$126 - $1,439	118%
Cignamajor	$194 - $1,100	182%
Humanamajor	$128	120%
AmeriHealth	$283	265%
Cigna HealthSpring	$126	118%
Fidelis Care	$56 - $126	52%
Independent Health	$56 - $126	52%
MVP Health Care	$56 - $194	52%
Oscar Health	$694	650%
UniCare	$1,100	1030%
WellCare	$138	129%
+ 41 smaller / regional plans	$56 - $1,693

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 7 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 76856.

Insurance Before you use insurance

Call your insurance company to confirm Good Samaritan Hospital Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 76856.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Good Samaritan Hospital Medical Center

Compare: Ultrasound, pelvis at other NY hospitals

Insurance negotiated median for the same procedure, sorted lowest first.