CMS Price Transparency Data

Ultrasound, pelvis

Facility: Presbyterian Community Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $43
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.40x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Presbyterian Community Hospital is $43. 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 0.40x the Medicare baseline. Located in 1451 Ashford Avenue, El Condado, San Juan, PR.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$43

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: $43 (40%)

Ins. Median: $43 (40% 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
International Medical Card	$20	19%
Union De Trabajadores De Muelles	$30	28%
Seguros De Servicios De Salud Vital	$37	35%
Medical Card System	$38	36%
Seguros De Servicios De Salud Com	$38	36%
Redbridge	$48	45%
Acaa	$49	46%
Plan De Salud Menonita	$55	51%
Humana	$67	63%
Mapfre	$75	70%
Seguros De Serv De Sa;Id Adv	$78	73%

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 Presbyterian Community 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.