CMS Price Transparency Data

Ultrasound, pelvis

Facility: Holland Community Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $199
Cash Discount Price: $212
vs. Medicare Baseline: 1.86x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Holland Community Hospital is $199. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $212. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.86x the Medicare baseline. Located in 602 Michigan Ave, Holland, MI.

Cash / Self-Pay

$212

Average discount available for prompt cash payment at this facility.

Insurance Median

$199

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: $212 (198%)

Insurance Median: $199 (186%)

Cash: $212 (198% of Medicare)

Ins. Median: $199 (186% 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
Life Circles-All Plans	$99	93%
Health Alliance Mcr Adv	$104	97%
Ph Mcr Adv	$104	97%
Va Ccn - All Plans	$104	97%
Aetna	$107 - $117	100%
Longevity Health Plan-All Plans	$112	105%
Molina Mcaid - All Plans	$113	106%
Ph Mcaid	$113	106%
Cofinity -All Plans	$158	148%
Cigna	$181	169%
Blue Cross Blue Shield	$182	170%
Sisco Epi	$199	186%
Sisco-All Other Plans	$199	186%
Priority Health - All Other Plans	$201	188%
Health Alliance Hmo	$236	221%
Asr - All Plans	$247	231%
Health Alliance Ahl - All Other Plans	$247	231%
Multiplan - All Plans	$307	287%
Benefit Source Inc-All Plans	$318	298%
First Health-All Plans	$318	298%
Usa Managed Care-All Plans	$318	298%
Integrated Health Plans-All Plans	$335	314%
UnitedHealthcare	$353	330%
Nomi Health - All Plans	$724	678%

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 $212.
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 Holland Community 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.