CMS Price Transparency Data

Ultrasound, pelvis

Facility: Charlevoix Area Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $128
Cash Discount Price: $495
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Charlevoix Area Hospital is $128. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $495. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.20x the Medicare baseline. Located in 14700 Lakeshore Drive, Charlevoix, MI.

Cash / Self-Pay

$495

Average discount available for prompt cash payment at this facility.

Insurance Median

$128

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: $495 (463%)

Insurance Median: $128 (120%)

Cash: $495 (463% of Medicare)

Ins. Median: $128 (120% 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
Blue Cross Blue Shield	$21 - $538	20%
Mclaren Health Plan	$21 - $542	20%
Meridian	$21 - $74	20%
Priority Health	$21 - $582	20%
UnitedHealthcare	$21 - $506	20%
Aetna	$32 - $526	30%
Blue Care Network	$32 - $274	30%
Hap (Health Alliance Plan)	$32 - $466	30%
Medicare (plans)	$32 - $274	30%
Michigan Amish Medical Board	$32 - $274	30%
Molina	$32 - $295	30%
Northern Michigan Mennonite Group	$32 - $274	30%
Asr Physicians Care Network	$48 - $466	45%
Cigna	$49 - $582	46%
Nomi Health	$51 - $541	48%
Employee Benefits Logistics	$54 - $465	51%
Provider Network Of America/Hma Group Health	$147 - $495	138%
Hospice Of Michigan	$349	327%
Enterprise Group Planning Employee Benefit Plan	$466	436%
First Health/Coventry Health/Community Care Network	$466	436%
Medical Cost Savings Solution	$466	436%
Three Rivers Provider Network	$495	463%
Iba Health And Life Assurance Company	$535	501%
Cofinity	$541	507%
Preferred Medical Claim Solutions	$553	518%

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 $495.
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 Charlevoix Area 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.