CMS Price Transparency Data

Ultrasound, pelvis

Facility: Mercyone Elkader Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76856
  • Insurance Median: $677
  • Cash Discount Price: $598
  • vs. Medicare Baseline: 6.34x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at Mercyone Elkader Medical Center is $677. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $598. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.34x the Medicare baseline. Located in 901 Davidson Street Nw, Elkader, IA.
Cash / Self-Pay
$598

Average discount available for prompt cash payment at this facility.

Insurance Median
$677

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: $598 (560%)
Insurance Median: $677 (634%)
Cash: $598 (560% of Medicare)
Ins. Median: $677 (634% 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 634% of the Medicare baseline (a markup of 534%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

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
Blue Cross Blue Shield $474 444%
Aetna $478 - $677 448%
Medicare (plans) $483 - $497 452%
UnitedHealthcare $507 - $690 475%
Iowa Total Care $572 536%
Medicaid / KanCare $581 - $584 544%
Amish Hospital Aid $636 595%
1199 National Benefit Fund $677 634%
Allied Benefit Systems $677 634%
Asr Health Benefits $677 634%
Christian Brother Services $677 634%
Coventry $677 634%
First Health $677 634%
Lucent Health $677 634%
Luminare Health $677 634%
Medical Mutual $677 634%
Meritain $677 634%
Trustmark Small Business Benefits $677 634%
Webtpa $677 634%
Geha $690 646%
Centivo $718 672%
Health Choices $736 689%
Medical Associates $736 689%
Ambetter / Centene $804 753%
Health Partners $885 829%
Auxiant $902 844%
Cigna $902 844%
Medica $902 844%
Midlands $902 844%
Midlands Choice $902 844%
Crime Victim Assistance $920 861%
Iowa Dept Of Public Health $920 861%
Claimdoc $962 901%
Nova $962 901%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 901 Davidson Street Nw, Elkader, IA 52043
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals