CMS Price Transparency Data

Ultrasound, pelvis

Facility: Memorial Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $289
Cash Discount Price: $1,027
vs. Medicare Baseline: 2.71x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Memorial Hospital is $289. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,027. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.71x the Medicare baseline. Located in 715 South Taft Avenue, Fremont, OH.

Cash / Self-Pay

$1,027

Average discount available for prompt cash payment at this facility.

Insurance Median

$289

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: $1,027 (962%)

Insurance Median: $289 (271%)

Cash: $1,027 (962% of Medicare)

Ins. Median: $289 (271% 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 271% of the Medicare baseline (a markup of 171%). 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
Medical Mutual Of Ohio	$57 - $1,055	53%
Meridian Health Plan Of Mi	$57 - $1,054	53%
Aetna	$62 - $1,621	58%
Summacare	$90 - $869	84%
Paramount Healthcare Inc	$94 - $885	88%
Blue Cross Blue Shield	$96 - $1,621	90%
Buckeye Community Health Plan	$97 - $1,621	91%
Frontpath	$97 - $965	91%
Health Alliance Plan	$97 - $1,621	91%
Humana	$97 - $1,054	91%
Molina Healthcare Of Ohio	$97 - $1,621	91%
Caresource	$98 - $1,621	92%
UnitedHealthcare	$103 - $1,621	96%
Cigna	$110 - $1,101	103%
Health Ohio Network	$134 - $1,135	125%
Amerihealth	$157 - $305	147%
Multiplan	$313 - $1,422	293%

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 $1,027.
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 Memorial 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.