CMS Price Transparency Data

Ultrasound, pelvis

Facility: Nationwide Children's Hospital Toledo, LLC

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $171
Cash Discount Price: $1,508
vs. Medicare Baseline: 1.60x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Nationwide Children's Hospital Toledo, LLC is $171. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,508. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.60x the Medicare baseline. Located in 2213 Cherry Street, Toledo, OH.

Cash / Self-Pay

$1,508

Average discount available for prompt cash payment at this facility.

Insurance Median

$171

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: $1,508 (1412%)

Insurance Median: $171 (160%)

Cash: $1,508 (1412% of Medicare)

Ins. Median: $171 (160% 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
Mcclaren Health Plan - Michigan	$21 - $110	20%
Caresource	$32 - $112	30%
Paramount	$32	30%
Blue Cross Blue Shield	$33 - $1,282	31%
Front Path Health Coalition	$41 - $1,131	38%
Mcclaren Health Plan	$44 - $1,131	41%
Aetna	$58 - $968	54%
UnitedHealthcare	$80 - $1,270	75%
Cigna	$102 - $309	95%
Molina	$107 - $170	100%
Ohc	$150 - $1,257	140%
Ohio Ppo Connect	$150 - $1,257	140%
Amerihealth	$172	161%
Bchp	$172	161%
Humana	$172	161%
Mmo	$628 - $880	588%
First Health	$1,936	1813%

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 $1,508.
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 Nationwide Children's Hospital Toledo, LLC 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.