CMS Price Transparency Data

Ultrasound, pelvis

Facility: Kootenai Health

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $104
Cash Discount Price: $498
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Kootenai Health is $104. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $498. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.97x the Medicare baseline. Located in 2003 Kootenai Health Way, Coeur D'Alene, ID.

Cash / Self-Pay

$498

Average discount available for prompt cash payment at this facility.

Insurance Median

$104

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: $498 (466%)

Insurance Median: $104 (97%)

Cash: $498 (466% of Medicare)

Ins. Median: $104 (97% 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
Coordinated Care Of Washington	$20 - $65	19%
Molina Healthcare Of Idaho	$20 - $246	19%
Molina Healthcare Of Washington	$20 - $65	19%
Blue Cross Blue Shield	$31 - $604	29%
Humana	$31 - $108	29%
Pacificsource	$31 - $544	29%
Premera	$31 - $410	29%
Regence Blue Shield Of Idaho	$31 - $108	29%
UnitedHealthcare	$31 - $598	29%
Aetna	$33 - $551	31%
Group Health/Kaiser	$44 - $389	41%
Magellan	$63 - $93	59%
Wellpoint	$63 - $93	59%
Mountain Health Co-Op	$515	482%
Cigna	$544 - $552	509%
Interwest Health	$564	528%
First Choice Health (Ameriben)	$566 - $575	530%

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 $498.
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 Kootenai Health 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.