CMS Price Transparency Data

Ultrasound, pelvis

Facility: Bella Vista Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $60
Cash Discount Price: $100
vs. Medicare Baseline: 0.56x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Bella Vista Hospital is $60. 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 0.56x the Medicare baseline. Located in Carr 349 Km 2 7 Cerro Las Mesas, Mayaguez, PR.

Cash / Self-Pay

$100

Average discount available for prompt cash payment at this facility.

Insurance Median

$60

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: $60 (56%)

Cash: $100 (94% of Medicare)

Ins. Median: $60 (56% 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
Fondo Del Seguro Del Estado	$35	33%
First Medical Vital	$38	36%
Mapfre Life Insurance Life Insurance	$38	36%
Mcs	$38	36%
Medicare (plans)	$38 - $79	36%
Triple S	$38	36%
International Medical Card	$40	37%
Triple S Vital	$42	39%
Acaa	$49	46%
Plan Salud Menonita Vital	$60	56%
Plan Salud Menonita	$75	70%
Servicios De Salud Bella Vista	$75	70%
Champva	$79	74%
Preferred Medical Choice(Pmc)	$79	74%
Tricare	$79	74%
UnitedHealthcare	$79	74%
Asociacion Maestros (Prossam)	$80	75%
Triple S Advantage	$83	78%

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 Bella Vista 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.