CMS Price Transparency Data

Ultrasound, pelvis

Facility: Ascension Providence Hospital, Southfield and Novi

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $104
Cash Discount Price: $322
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Ascension Providence Hospital, Southfield and Novi is $104. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $322. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.97x the Medicare baseline. Located in 16001 W Nine Mile Rd, Southfield, MI.

Cash / Self-Pay

$322

Average discount available for prompt cash payment at this facility.

Insurance Median

$104

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: $322 (301%)

Insurance Median: $104 (97%)

Cash: $322 (301% of Medicare)

Ins. Median: $104 (97% 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
Blue Caid Michigan	$60	56%
Harbor Health Mcd	$60	56%
Medicaid / KanCare	$60 - $104	56%
Molina Health	$60 - $81	56%
Total Health Care	$60	56%
UnitedHealthcare	$60	56%
Priority Ppo	$77	72%
Hap Alliance Health	$84	79%
Hap Hmo Pos	$84	79%
Amerihealth Vip Care Mcr	$90 - $103	84%
Priority Health Hmo	$90	84%
Hap Preferred	$99	93%
Aetna	$104 - $214	97%
Auto Insurance	$104	97%
Jvhl - Mcr Replacement	$104	97%
Mcr Replacement	$104	97%
Veterans Choice	$104	97%
Humana	$105	98%
Meridian Wellcare	$109	102%
Molina Advantage	$109	102%
Bc Metro Detroit Epo	$114 - $151	107%
Bc Metro Detroit Hmo	$128 - $151	120%
Ambetter / Centene	$130	122%
Molina Marketplace	$130	122%
Smart Health	$144	135%
Bcn Local Network Southeast	$150 - $151	140%
Blue Care Network	$150 - $151	140%
Blue Cross Blue Shield	$150 - $151	140%

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 $322.
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 Ascension Providence Hospital, Southfield and Novi 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.