Ultrasound, pelvis
Facility: Saint John Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $103
- Cash Discount Price: $98
- vs. Medicare Baseline: 0.96x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $60 | 56% |
| Blue Cross Blue Shield | $63 - $133 | 59% |
| UnitedHealthcare | $91 - $138 | 85% |
| Healthy Blue | $93 - $103 | 87% |
| Celtic | $93 - $158 | 87% |
| Tricare | $98 | 92% |
| Cigna | $98 | 92% |
| Medicare (plans) | $98 | 92% |
| Aetna | $98 - $138 | 92% |
| Midland Care Connection | $98 | 92% |
| Kansas Superior Select | $100 | 94% |
| Comp Alliance Workers Comp | $112 | 105% |
| Oha Networks | $121 | 113% |
| Worker Compensation | $125 | 117% |
| Employer Direct Healthcare | $138 | 129% |
| Well Path | $138 | 129% |
| Corizon | $138 | 129% |
| Centurion | $148 | 139% |
| Naphcare | $153 | 143% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure on the pelvis at Saint John Hospital in Leavenworth, KS, the facility's cash price of $98.00 is significantly lower than the average amount paid by insurance plans, which ranges from $60 to $158 depending on the carrier. While the hospital's negotiated rates with major payers like Blue Cross Blue Shield and UnitedHealthcare fall between $63 and $138, the cash price serves as a useful benchmark for patients with high-deductible plans who may find paying out-of-pocket more cost-effective than waiting for insurance to cover the service. It is important to note that the facility's cash rate is also lower than the Medicare benchmark of $106.81, suggesting that the base cost of this service is well below the federal standard, though commercial insurance contracts often include administrative overhead that inflates the final allowed amount.
Patients should be aware that while Saint John Hospital is a voluntary non-profit acute care facility, the final amount you owe depends heavily on your specific insurance plan and whether you qualify for prompt-pay discounts. If you choose to pay cash upfront, you may be eligible for a discount that could further reduce the $98.00 base price, bypassing the administrative costs and claim processing fees that typically add 20% to 40% to the negotiated rate. Before scheduling, it is advisable to confirm with the hospital's billing department whether they offer self-pay or prompt-pay rates and to request a waiver of insurance submission to ensure you are not automatically billed the higher negotiated amount. Always verify the exact allowed amount with your insurer, as some plans may pay less than the cash price even when the service is covered.