Ultrasound, pelvis
Facility: Providence Medical Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $112
- Cash Discount Price: $98
- vs. Medicare Baseline: 1.05x 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% |
| UnitedHealthcare | $91 - $215 | 85% |
| Celtic | $93 - $158 | 87% |
| Healthy Blue | $93 - $103 | 87% |
| Medicare (plans) | $98 | 92% |
| Tricare | $98 | 92% |
| Midland Care Connection | $98 | 92% |
| Aetna | $98 - $138 | 92% |
| Cigna | $98 | 92% |
| Kansas Superior Select | $103 | 96% |
| Comp Alliance - Fka Compresults Worker Compensation | $112 | 105% |
| Oha Networks | $121 | 113% |
| Worker Compensation | $125 | 117% |
| Corizon | $128 | 120% |
| Well Path Prison | $138 | 129% |
| Employer Direct Healthcare | $138 | 129% |
| Centurion | $148 | 139% |
| Naphcare | $153 | 143% |
| Blue Cross Blue Shield | $158 - $255 | 148% |
| First Health | $750 | 702% |
Consumer Guidance & Cost Commentary
For the pelvic ultrasound procedure (CPT 76856) at Providence Medical Center in Kansas City, KS, the cash median price is $98.00, which is significantly lower than the facility's negotiated rates and the state average. While the facility's cash rate is $98.00, the median negotiated rate across payers is $112.00, and the highest negotiated rates reach up to $750.00 with First Health. Because commercial insurance contracts often include administrative overhead and markup, paying cash directly can result in substantial savings compared to using an in-network plan, particularly for patients with high deductibles who may face higher out-of-pocket costs. It is advisable to confirm with the hospital's billing department whether "self-pay" or "prompt-pay" discounts are available, as these upfront payment options can further reduce the final amount owed.
When evaluating this charge, it is important to compare the facility's pricing against the Medicare benchmark, which serves as the objective baseline for healthcare costs. The Medicare amount for this service is $106.81, and the facility's cash rate of $98.00 is slightly below this benchmark, indicating a fair price relative to the federal standard. In contrast, many commercial negotiated rates exceed 200% of the Medicare rate, highlighting the potential for significant overcharging if not carefully reviewed. To ensure accuracy, patients should request an itemized bill that breaks down the specific CPT codes and unit costs, avoiding summary bills that may obscure individual charges. If any errors are found, such as unbundled services or charges for items not rendered, a formal written dispute should be sent to the billing supervisor to resolve