CMS Price Transparency Data

Ultrasound, pelvis

Facility: Caribbean Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $35
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.33x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Caribbean Medical Center is $35. 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 0.33x the Medicare baseline. Located in 151 Ave Osvaldo Molina, Fajardo, PR.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$35

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: $35 (33%)

Ins. Median: $35 (33% 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
Hoffa	$20 - $35	19%
Imc Privado	$20 - $35	19%
Veteran Administration	$25 - $31	23%
Menonita Ases	$27 - $88	25%
Humana	$31 - $73	29%
Medicare (plans)	$31 - $78	29%
Mmm	$31 - $66	29%
Tricare	$31 - $78	29%
Champva	$33 - $78	31%
First Medical Ases	$33 - $75	31%
Mmm Multi Health Ases	$33 - $75	31%
Triples S Reforma	$33 - $42	31%
Health First	$34	32%
UnitedHealthcare	$34 - $35	32%
Well Care	$34 - $78	32%
Acaa	$35 - $49	33%
Ace	$35	33%
American Health	$35	33%
Asociacion De Maestros Pr	$35 - $70	33%
Atlantic Southern	$35	33%
Auxilio Mutuo	$35 - $75	33%
Auxilio Mutuo Plus	$35 - $75	33%
Cfse	$35 - $114	33%
Cigna	$35	33%
Comercial Others	$35	33%
Cosvi Seg Esco	$35	33%
Global Health Plan	$35	33%
Int Life Insurance	$35	33%
Mapfre	$35 - $38	33%
Mcs Classicare	$35 - $38	33%
Mcs Privado	$35 - $38	33%
Menonita Privado	$35 - $75	33%
National Life Seg Esco	$35	33%
Preferrd Health	$35	33%
Triple S Privado	$35 - $38	33%
Tsa	$35 - $78	33%
Union Carpinteros	$35 - $38	33%
Union Independiente Acueductos	$35	33%
Panamerican Life Insurance	$45	42%

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 Caribbean Medical 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.