CMS Price Transparency Data

Ultrasound, pelvis

Facility: Mercyone Waterloo Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76856
  • Insurance Median: $167
  • Cash Discount Price: $875
  • vs. Medicare Baseline: 1.56x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at Mercyone Waterloo Medical Center is $167. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $875. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.56x the Medicare baseline. Located in 3421 West Ninth Street, Waterloo, IA.
Cash / Self-Pay
$875

Average discount available for prompt cash payment at this facility.

Insurance Median
$167

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: $875 (819%)
Insurance Median: $167 (156%)
Cash: $875 (819% of Medicare)
Ins. Median: $167 (156% 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
Aetna $98 - $407 92%
Medicare (plans) $98 - $103 92%
Blue Cross Blue Shield $99 - $107 93%
Iowa Total Care $100 94%
UnitedHealthcare $100 - $1,346 94%
Medicaid / KanCare $101 - $102 95%
Bcn Domestic $107 100%
Blue Benefit Administrators Of Massachusetts $107 100%
Blue Care Network $107 100%
Blue Distinction Transplant $107 100%
Blue Shield - Ca $107 100%
Blue Shield - Id (Regence) $107 100%
Blue Shield - Ny Highmark Northeastern $107 100%
Blue Shield - Ny Highmark Western $107 100%
Blue Shield - Pa (Highmark) $107 100%
Blue Shield - Wa (Regence) $107 100%
Kaiser Domestic $107 100%
Pre-Employment $107 100%
Wc Domestic $107 100%
Amish Hospital Aid $134 125%
Oscar $154 144%
Centivo $167 156%
Ambetter / Centene $169 158%
Claimdoc $202 189%
Nova $202 189%
Geha $240 225%
Health Choices $316 296%
Medical Associates $316 296%
Allied Benefit Systems $407 381%
Asr Health Benefits $407 381%
Christian Brother Services $407 381%
Coventry $407 381%
First Health $407 381%
Lucent Health $407 381%
Luminare Health $407 381%
Medical Mutual $407 381%
Meritain $407 381%
Webtpa $407 381%
Health Partners $883 827%
Auxiant $956 895%
Cigna $956 895%
Medica $956 895%
Midlands $956 895%
Midlands Choice $956 895%
Iowa Dept Of Public Health $1,346 1260%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3421 West Ninth Street, Waterloo, IA 50702
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals