CMS Price Transparency Data

Ultrasound, pelvis

Facility: Southwest General Health Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76856
  • Insurance Median: $169
  • Cash Discount Price: $719
  • vs. Medicare Baseline: 1.58x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at Southwest General Health Center is $169. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $719. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.58x the Medicare baseline. Located in 18697 Bagley Road, Middleburg Heights, OH.
Cash / Self-Pay
$719

Average discount available for prompt cash payment at this facility.

Insurance Median
$169

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: $719 (673%)
Insurance Median: $169 (158%)
Cash: $719 (673% of Medicare)
Ins. Median: $169 (158% 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.

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
Medical Mutual $42 - $46 39%
Medical Mutual-Ohio $42 - $137 39%
Buckeye $72 - $169 67%
Caresource $72 - $169 67%
Humana $72 - $374 67%
Molina $72 - $169 67%
UnitedHealthcare $72 - $518 67%
Amerihealth Caritas $74 - $169 69%
Blue Cross Blue Shield $137 - $182 128%
Valor Health $137 128%
Healthsmart $307 287%
Health Design Plus $355 332%
Clarity Health $384 360%
Healthspan $384 360%
Healthsmart Preferred $432 404%
Ohio Health Choice Plus $464 434%
Summacare $518 485%
Aetna $519 486%
Cigna $525 492%
Coventry $662 620%
First Health $662 620%
Ohio Health Choice $741 694%
Private Healthare Systems $767 718%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 18697 Bagley Road, Middleburg Heights, OH 44130
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals