CMS Price Transparency Data
Ultrasound, pelvis
Facility: Mercy Health Lakeshore Campus
Billing Code: 76856 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 76856
- Insurance Median: $554
- Cash Discount Price: $402
- vs. Medicare Baseline: 5.19x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at Mercy Health Lakeshore Campus is $554. 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 5.19x the Medicare baseline. Located in 72 South State Street, Shelby, MI.
Cash / Self-Pay
$402
Average discount available for prompt cash payment at this facility.
Insurance Median
$554
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: $554 (519%)
Cash: $402 (376% of Medicare)
Ins. Median: $554 (519% 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 519% of the Medicare baseline (a markup of 419%). 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 | $79 - $152 | 74% |
| Medicaid / KanCare | $79 - $80 | 74% |
| Access Health | $108 | 101% |
| Blue Care Network Advantage | $152 | 142% |
| Medicare (plans) | $152 | 142% |
| Aetna | $155 | 145% |
| Align Senior Care | $155 | 145% |
| Correctional Recovery | $155 | 145% |
| Wellpath | $156 | 146% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $174 | 163% |
| Oscar | $190 | 178% |
| Vitalcore | $206 | 193% |
| UnitedHealthcare | $217 - $557 | 203% |
| U Of M Health Plan | $229 - $554 | 214% |
| Molina Marketplace | $258 | 242% |
| Hospice Of Michigan | $340 | 318% |
| Nomi Health | $347 | 325% |
| Hap | $464 - $568 | 434% |
| Wc Accident Fund | $488 | 457% |
| Wc Advantage | $488 | 457% |
| Wc Aig | $488 | 457% |
| Wc Allied | $488 | 457% |
| Wc Amerisure | $488 | 457% |
| Wc Amtrust | $488 | 457% |
| Wc Asu Risk Mgt | $488 | 457% |
| Wc Berkley Admin | $488 | 457% |
| Wc Broadspire | $488 | 457% |
| Wc Bunch & Associates | $488 | 457% |
| Wc Ccmsi | $488 | 457% |
| Wc Emc Insurance Company | $488 | 457% |
| Wc Esis | $488 | 457% |
| Wc Fcci | $488 | 457% |
| Wc Federated | $488 | 457% |
| Wc Gallagher Bassett | $488 | 457% |
| Wc Genex Care For Ohio | $488 | 457% |
| Wc Guard Insurance Company | $488 | 457% |
| Wc Hartford | $488 | 457% |
| Wc Liberty Mutual | $488 | 457% |
| Wc Meijers | $488 | 457% |
| Wc Michigan | $488 | 457% |
| Wc Mitchell Frankenmuth | $488 | 457% |
| Wc Pma | $488 | 457% |
| Wc Sedgwick | $488 | 457% |
| Wc Sentry | $488 | 457% |
| Wc Travelers | $488 | 457% |
| Wc Tristar | $488 | 457% |
| Wc Walmart | $488 | 457% |
| Wc Zurich | $488 | 457% |
| Asr Health Benefits | $516 | 483% |
| 1199 National Benefit Fund | $532 | 498% |
| Allied National Global Care | $532 | 498% |
| Asrm - Reliance Standard Life Insurance | $532 | 498% |
| Christian Care Ministry | $532 | 498% |
| Dean Health | $532 | 498% |
| Fallon Health | $532 | 498% |
| Family Life Insurance Company | $532 | 498% |
| Ghc Scw | $532 | 498% |
| Group Pension Administrators | $532 | 498% |
| International Benefit Administrators | $532 | 498% |
| Lifetime Benefit Solutions | $532 | 498% |
| Manhattan Life | $532 | 498% |
| Medi Share | $532 | 498% |
| Multiplan | $532 | 498% |
| Mvp | $532 | 498% |
| Pai | $532 | 498% |
| Pan-American Life | $532 | 498% |
| Paramount Hmo | $532 | 498% |
| Phcs | $532 | 498% |
| Trinity Health Share | $532 | 498% |
| Cigna | $537 | 503% |
| Caresource | $552 | 517% |
| Acclaim | $554 | 519% |
| Administrative Concepts | $554 | 519% |
| Allegeant | $554 | 519% |
| Allied Benefit Systems | $554 | 519% |
| Ameriben | $554 | 519% |
| American Family | $554 | 519% |
| American Healthcare Alliance | $554 | 519% |
| American Republic | $554 | 519% |
| Amerihealth | $554 | 519% |
| Aultcare | $554 | 519% |
| Automated Benefit Services | $554 | 519% |
| Auxiant | $554 | 519% |
| Benefit Administrative Systems,Llc | $554 | 519% |
| Boon Chapman | $554 | 519% |
| Cam Administrative Services | $554 | 519% |
| Christian Brother Services | $554 | 519% |
| Christian Brothers Holy Cross | $554 | 519% |
| Claimchoice Adminstrators | $554 | 519% |
| Comprehensive Benefits | $554 | 519% |
| Consociate | $554 | 519% |
| Continental Life Insurance | $554 | 519% |
| Custom Benefit Administrators | $554 | 519% |
| Cypress Benefit Administrators | $554 | 519% |
| Employee Benefit Concepts | $554 | 519% |
| Employee Benefit Management | $554 | 519% |
| Enterprise Group Planning | $554 | 519% |
| Forest County Potawatomi | $554 | 519% |
| Freedom Life Insurance Company | $554 | 519% |
| Group Administrators | $554 | 519% |
| Group Marketing Services | $554 | 519% |
| Guardian | $554 | 519% |
| Health America | $554 | 519% |
| Health Choices | $554 | 519% |
| Health Smart | $554 | 519% |
| Healthez | $554 | 519% |
| Healthgram | $554 | 519% |
| Healthscope | $554 | 519% |
| Humana | $554 | 519% |
| Insight | $554 | 519% |
| Intercare | $554 | 519% |
| Jfp Benefit Management | $554 | 519% |
| Jp Farley Corporation | $554 | 519% |
| Key Benefit Administrator | $554 | 519% |
| Liberty Union Life Assurance Co | $554 | 519% |
| Lucent Health | $554 | 519% |
| Luminare Health | $554 | 519% |
| Luminare Health (Detroit) | $554 | 519% |
| Medben | $554 | 519% |
| Medcost | $554 | 519% |
| Medical Mutual | $554 | 519% |
| Mutual Health Services | $554 | 519% |
| Mutual Of Omaha | $554 | 519% |
| Ncas | $554 | 519% |
| Nippon Life Ins | $554 | 519% |
| Nova | $554 | 519% |
| Painters Union Insurance Fund | $554 | 519% |
| Physicians Mutual | $554 | 519% |
| Plumbers Local 98 Insurance Fund | $554 | 519% |
| Prairie States | $554 | 519% |
| Primary Physician Care | $554 | 519% |
| Professional Benefit Administrators | $554 | 519% |
| Secureone Preferred United Plans | $554 | 519% |
| The Loomis Company | $554 | 519% |
| Trustmark Small Business Benefits | $554 | 519% |
| Unicare | $554 | 519% |
| Unified Group Services | $554 | 519% |
| Us Health And Life | $554 | 519% |
| Valenz | $554 | 519% |
| Varipro | $554 - $568 | 519% |
| Western & Southern Financial Group | $554 | 519% |
| Wps | $554 | 519% |
| Geha | $557 | 521% |
| Priority Health | $558 | 522% |
| First Health | $560 | 524% |