CMS Price Transparency Data
Ultrasound, pelvis
Facility: Mercy Health Saint Mary's
Billing Code: 76856 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 76856
- Insurance Median: $452
- Cash Discount Price: $402
- vs. Medicare Baseline: 4.23x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at Mercy Health Saint Mary's is $452. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $402. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.23x the Medicare baseline. Located in 200 Jefferson Avenue Se, Grand Rapids, MI.
Cash / Self-Pay
$402
Average discount available for prompt cash payment at this facility.
Insurance Median
$452
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: $402 (376%)
Insurance Median: $452 (423%)
Cash: $402 (376% of Medicare)
Ins. Median: $452 (423% 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 423% of the Medicare baseline (a markup of 323%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
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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 Cross Blue Shield | $58 - $116 | 54% |
| Medicaid / KanCare | $58 - $60 | 54% |
| Access Health | $73 | 68% |
| Aetna | $82 - $102 | 77% |
| Geha | $82 - $470 | 77% |
| Medical Mutual | $82 | 77% |
| Meritain | $82 | 77% |
| Preferred One | $82 | 77% |
| Blue Care Network Advantage | $102 | 95% |
| Medicare (plans) | $102 | 95% |
| Align Senior Care | $104 | 97% |
| Correctional Recovery | $104 | 97% |
| Hospice Faith | $104 | 97% |
| Hospice Of Holland | $104 | 97% |
| UnitedHealthcare | $107 - $619 | 100% |
| Bcn Domestic | $116 | 109% |
| Blue Benefit Administrators Of Massachusetts | $116 | 109% |
| Blue Care Network | $116 | 109% |
| Blue Distinction Transplant | $116 | 109% |
| Blue Shield - Ca | $116 | 109% |
| Blue Shield - Id (Regence) | $116 | 109% |
| Blue Shield - Ny Highmark Northeastern | $116 | 109% |
| Blue Shield - Ny Highmark Western | $116 | 109% |
| Blue Shield - Pa (Highmark) | $116 | 109% |
| Blue Shield - Wa (Regence) | $116 | 109% |
| Health Choices | $116 - $471 | 109% |
| Kaiser Domestic | $116 | 109% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $117 | 110% |
| Oscar | $133 | 125% |
| Molina Marketplace | $135 | 126% |
| Vitalcore | $161 | 151% |
| Wellpath | $161 | 151% |
| Priority Health | $223 - $404 | 209% |
| U Of M Health Plan | $229 - $471 | 214% |
| Wc Accident Fund | $338 | 316% |
| Wc Advantage | $338 | 316% |
| Wc Aig | $338 | 316% |
| Wc Allied | $338 | 316% |
| Wc Amerisure | $338 | 316% |
| Wc Amtrust | $338 | 316% |
| Wc Asu Risk Mgt | $338 | 316% |
| Wc Berkley Admin | $338 | 316% |
| Wc Broadspire | $338 | 316% |
| Wc Bunch & Associates | $338 | 316% |
| Wc Ccmsi | $338 | 316% |
| Wc Emc Insurance Company | $338 | 316% |
| Wc Esis | $338 | 316% |
| Wc Fcci | $338 | 316% |
| Wc Federated | $338 | 316% |
| Wc Gallagher Bassett | $338 | 316% |
| Wc Genex Care For Ohio | $338 | 316% |
| Wc Guard Insurance Company | $338 | 316% |
| Wc Hartford | $338 | 316% |
| Wc Liberty Mutual | $338 | 316% |
| Wc Meijers | $338 | 316% |
| Wc Michigan | $338 | 316% |
| Wc Mitchell Frankenmuth | $338 | 316% |
| Wc Pma | $338 | 316% |
| Wc Sedgwick | $338 | 316% |
| Wc Sentry | $338 | 316% |
| Wc Travelers | $338 | 316% |
| Wc Tristar | $338 | 316% |
| Wc Walmart | $338 | 316% |
| Wc Zurich | $338 | 316% |
| Nomi Health | $347 | 325% |
| Acs Benefit Services | $356 | 333% |
| Allied Benefit Systems | $356 | 333% |
| Claimchoice Adminstrators | $356 | 333% |
| Consociate | $356 | 333% |
| Cypress Benefit Administrators | $356 | 333% |
| Forest County Potawatomi | $356 | 333% |
| Health Smart | $356 | 333% |
| Healthgram | $356 | 333% |
| Healthscope | $356 | 333% |
| Secureone Preferred United Plans | $356 | 333% |
| Sisco Benefits | $356 | 333% |
| The Health Plan | $356 | 333% |
| Trustmark Small Business Benefits | $356 | 333% |
| Unified Group Services | $356 | 333% |
| Webtpa | $356 | 333% |
| Asr Health Benefits | $394 | 369% |
| Hap | $394 - $480 | 369% |
| Varipro | $402 | 376% |
| Caresource | $404 | 378% |
| 1199 National Benefit Fund | $452 | 423% |
| Allied National Global Care | $452 | 423% |
| Asrm - Reliance Standard Life Insurance | $452 | 423% |
| Christian Care Ministry | $452 | 423% |
| Cigna | $452 | 423% |
| Dean Health | $452 | 423% |
| Fallon Health | $452 | 423% |
| Family Life Insurance Company | $452 | 423% |
| Ghc Scw | $452 | 423% |
| Group Pension Administrators | $452 | 423% |
| International Benefit Administrators | $452 | 423% |
| Lifetime Benefit Solutions | $452 | 423% |
| Manhattan Life | $452 | 423% |
| Medi Share | $452 | 423% |
| Multiplan | $452 | 423% |
| Mvp | $452 | 423% |
| Pai | $452 | 423% |
| Pan-American Life | $452 | 423% |
| Paramount Hmo | $452 | 423% |
| Phcs | $452 | 423% |
| Trinity Health Share | $452 | 423% |
| Acclaim | $471 | 441% |
| Administrative Concepts | $471 | 441% |
| Allegeant | $471 | 441% |
| Ameriben | $471 | 441% |
| American Family | $471 | 441% |
| American Healthcare Alliance | $471 | 441% |
| American Republic | $471 | 441% |
| Amerihealth | $471 | 441% |
| Aultcare | $471 | 441% |
| Automated Benefit Services | $471 | 441% |
| Auxiant | $471 | 441% |
| Benefit Administrative Systems,Llc | $471 | 441% |
| Boon Chapman | $471 | 441% |
| Cam Administrative Services | $471 | 441% |
| Christian Brother Services | $471 | 441% |
| Christian Brothers Holy Cross | $471 | 441% |
| Comprehensive Benefits | $471 | 441% |
| Continental Life Insurance | $471 | 441% |
| Custom Benefit Administrators | $471 | 441% |
| Employee Benefit Concepts | $471 | 441% |
| Employee Benefit Management | $471 | 441% |
| Enterprise Group Planning | $471 | 441% |
| Freedom Life Insurance Company | $471 | 441% |
| Group Administrators | $471 | 441% |
| Group Marketing Services | $471 | 441% |
| Guardian | $471 | 441% |
| Health America | $471 | 441% |
| Healthez | $471 | 441% |
| Humana | $471 - $619 | 441% |
| Insight | $471 | 441% |
| Intercare | $471 | 441% |
| Jfp Benefit Management | $471 | 441% |
| Jp Farley Corporation | $471 | 441% |
| Key Benefit Administrator | $471 | 441% |
| Liberty Union Life Assurance Co | $471 | 441% |
| Lucent Health | $471 | 441% |
| Luminare Health | $471 | 441% |
| Luminare Health (Detroit) | $471 | 441% |
| Medben | $471 | 441% |
| Medcost | $471 | 441% |
| Mutual Health Services | $471 | 441% |
| Mutual Of Omaha | $471 | 441% |
| Ncas | $471 | 441% |
| Nippon Life Ins | $471 | 441% |
| Nova | $471 | 441% |
| Painters Union Insurance Fund | $471 | 441% |
| Physicians Mutual | $471 | 441% |
| Plumbers Local 98 Insurance Fund | $471 | 441% |
| Prairie States | $471 | 441% |
| Primary Physician Care | $471 | 441% |
| Professional Benefit Administrators | $471 | 441% |
| The Loomis Company | $471 | 441% |
| Unicare | $471 | 441% |
| Us Health And Life | $471 | 441% |
| Valenz | $471 | 441% |
| Western & Southern Financial Group | $471 | 441% |
| Wps | $471 | 441% |
| Coventry | $490 | 459% |
| First Health | $490 | 459% |
| Cmh Allegan County | $619 | 580% |
| Cmh Ausable Valley | $619 | 580% |
| Cmh Barry County | $619 | 580% |
| Cmh Berrien County | $619 | 580% |
| Cmh Cass County | $619 | 580% |
| Cmh Clinton-Eaton-Ingham County | $619 | 580% |
| Cmh Kalamazoo | $619 | 580% |
| Cmh Kent County | $619 | 580% |
| Cmh Lenawee County | $619 | 580% |
| Cmh Misc | $619 | 580% |
| Cmh Monroe County | $619 | 580% |
| Cmh Montcalm County | $619 | 580% |
| Cmh Muskegon County | $619 | 580% |
| Cmh Newaygo County | $619 | 580% |
| Cmh North Country | $619 | 580% |
| Cmh Northern Lakes County | $619 | 580% |
| Cmh Ottawa County | $619 | 580% |
| Cmh Van Buren County | $619 | 580% |
| Cmh West Mi County | $619 | 580% |
| Magellan Behavioral Health | $619 | 580% |