Ultrasound, pelvis
Facility: Overland Park Reg Med Ctr
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $612
- Cash Discount Price: $4,301
- vs. Medicare Baseline: 5.73x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 573% of the Medicare baseline (a markup of 473%). 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| United | $60 - $2,130 | 56% |
| Amerigroup | $60 | 56% |
| Healthyblue | $61 | 57% |
| Medicaid / KanCare | $62 | 58% |
| Aetna | $62 - $2,413 | 58% |
| Unicare | $62 | 58% |
| Home State Health Plan | $95 | 89% |
| Multiplan | $100 - $3,502 | 94% |
| Blue Cross Blue Shield | $108 - $2,035 | 101% |
| Corvel Corporation | $119 - $3,076 | 111% |
| Cigna | $122 - $181 | 114% |
| Oha Network | $124 - $2,366 | 116% |
| Ambetter / Centene | $154 - $880 | 144% |
| Nhc Advantage | $157 - $899 | 147% |
| Humana | $164 - $212 | 154% |
| Wppa Providrs Care Network | $165 - $946 | 154% |
| Universal Healthcare | $290 - $1,656 | 272% |
| Coventry | $333 - $1,902 | 312% |
| Coventry Kc Mo | $339 - $1,940 | 317% |
| College Park Family Care Center | $356 - $2,035 | 333% |
| Triwest Health Alliance | $620 - $3,549 | 580% |
| Cco, Inc. | $620 - $3,549 | 580% |
| Focus Healthcare Mgmt, Inc | $620 - $3,549 | 580% |
Consumer Guidance & Cost Commentary
For this ultrasound procedure at Overland Park Reg Med Ctr, the cash price of $4,301 is significantly higher than the state average, which sits at $612. While commercial insurance plans like United and Amerigroup offer negotiated rates ranging from $60 to $2,130, these figures often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that insurance negotiated rates include administrative overhead and contract markups, which can inflate the baseline price by 20% to 40% compared to direct cash payments. Before scheduling, patients should verify their specific plan's allowed amount and consider requesting a "self-pay" or "prompt-pay" discount, which typically reduces the bill by 20% to 50% if paid in full upfront, bypassing the costly claims processing cycle.
When reviewing your final invoice, always demand a detailed, itemized bill rather than accepting a summary statement, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that should be consolidated. If you receive a balance bill for services rendered at an in-network facility, you may be entitled to protections under the No Surprises Act, which bans balance billing for emergency care and non-emergency services from out-of-network providers. To protect your financial interests, do not sign consent waivers that waive surprise billing rights for mandatory ancillary services, and if a dispute arises, send a formal written audit request to the billing supervisor rather than settling verbally. Comparing your facility's rates to the Medicare benchmark of $106.81 reveals a substantial markup, highlighting the importance of understanding the