CMS Price Transparency Data

Ultrasound, pelvis

Facility: Ascension Providence Rochester Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $104
Cash Discount Price: $443
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Ascension Providence Rochester Hospital is $104. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $443. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.97x the Medicare baseline. Located in 1101 W University Drive, Rochester, MI.

Cash / Self-Pay

$443

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: $443 (415%)

Insurance Median: $104 (97%)

Cash: $443 (415% 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
Bluecaid	$56	52%
Medicaid / KanCare	$56	52%
Total Health Care Hmo	$56	52%
Hap	$77	72%
Smarthealth	$93	87%
Blue Cross Blue Shield	$104 - $202	97%
Hap Senior Plus	$104	97%
Humana	$104	97%
Medicare (plans)	$104 - $109	97%
Priority Health Advantage (Mcr)	$104	97%
- None -	$109	102%
Aetna	$128	120%
Meridian Health Plan	$130	122%
Mva	$198	185%
Blue Care Network	$202	189%

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 $443.
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 Rochester 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.