CMS Price Transparency Data

Ultrasound, pelvis

Facility: Franciscan Health Michigan City

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $993
Cash Discount Price: $344
vs. Medicare Baseline: 9.30x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Franciscan Health Michigan City is $993. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $344. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.30x the Medicare baseline. Located in 3500 Franciscan Way, Michigan City, IN.

Cash / Self-Pay

$344

Average discount available for prompt cash payment at this facility.

Insurance Median

$993

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: $344 (322%)

Insurance Median: $993 (930%)

Cash: $344 (322% of Medicare)

Ins. Median: $993 (930% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 930% of the Medicare baseline (a markup of 830%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Medicare (plans)	$111	104%
Blue Cross Blue Shield	$186 - $828	174%
Unicare [1150]	$186 - $381	174%
Workers Comp [1172]	$221	207%
Mdwise [1175]	$245	229%
Medicaid / KanCare	$245 - $294	229%
Aetna	$250	234%
Managed Care [2000]	$250 - $1,490	234%
Managed Health Services [1302]	$253	237%
Commercial [2001]	$481 - $1,656	450%
United Medical Resources [1158]	$992	929%
United Medical Resources [1301]	$992 - $1,103	929%
UnitedHealthcare	$992 - $1,103	929%
Cigna	$1,000 - $1,159	936%
Great West Insurance [1055]	$1,000	936%

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 $344.
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 Franciscan Health Michigan City 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.