CMS Price Transparency Data

Ultrasound, pelvis

Facility: University of Michigan Health - West

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $495
Cash Discount Price: $296
vs. Medicare Baseline: 4.63x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at University of Michigan Health - West is $495. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $296. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.63x the Medicare baseline. Located in 5900 Byron Center Avenue, Sw, Wyoming, MI.

Cash / Self-Pay

$296

Average discount available for prompt cash payment at this facility.

Insurance Median

$495

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: $296 (277%)

Insurance Median: $495 (463%)

Cash: $296 (277% of Medicare)

Ins. Median: $495 (463% 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 463% of the Medicare baseline (a markup of 363%). 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
Medicaid / KanCare	$57 - $174	53%
Molina Healthcare Of Mi	$57	53%
Care Resources	$96	90%
Humana	$107 - $555	100%
Insight Metro Care	$107	100%
Medicare (plans)	$107	100%
Molina Marketplace Commercial	$107	100%
Priority Health	$211	198%
Web Tpa	$325	304%
Aetna	$460 - $495	431%
Alliance Health & Life Ppo	$495	463%
Asr Physicians	$495	463%
Hap	$495	463%
Golden Rule Ins	$533	499%
Medica	$533	499%
Student Ins/Mega Life	$533	499%
UnitedHealthcare	$533	499%
Asr Cofinity	$617	578%
Cofinity Commercial	$617	578%
Cofinity Weyco	$617	578%
Core Source	$617	578%
Epoch Group	$617	578%
Health Partners	$617	578%
Hlthcomp Admin	$617	578%
Mid America	$617	578%

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 $296.
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 University of Michigan Health - West 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.