CMS Price Transparency Data

Ultrasound, pelvis

Facility: Hospital Metropolitano Dr Pila

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $45
Cash Discount Price: $100
vs. Medicare Baseline: 0.42x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Hospital Metropolitano Dr Pila is $45. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $100. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.42x the Medicare baseline. Located in 2435 Boulevard Luis A Ferre, Ponce, PR.

Cash / Self-Pay

$100

Average discount available for prompt cash payment at this facility.

Insurance Median

$45

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: $100 (94%)

Insurance Median: $45 (42%)

Cash: $100 (94% of Medicare)

Ins. Median: $45 (42% 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
Auxilio Mutuo	$19	18%
Acaa	$24	22%
First Medical	$30 - $48	28%
Triple S	$30 - $78	28%
Mc	$35	33%
Mso	$35 - $56	33%
Humana	$37 - $46	35%
Bl	$38	36%
Mcs	$38 - $77	36%
Plan De Salud Menonita	$38 - $45	36%
Privado	$38	36%
Cigna	$42	39%
Comerciales	$45	42%
Hospicio	$45	42%
Life Link	$45	42%
Wellcare	$45	42%
Prossam	$47	44%
Va	$50	47%
Aarp	$75	70%
Mapfre	$75	70%
Ch	$77	72%
Salud Correccional	$77	72%
Tricare	$77	72%
Fondo Del Seguro Estado	$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 $100.
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 Hospital Metropolitano Dr Pila 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.