Ultrasound, pelvis
Facility: Saint Luke'S South Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $514
- Cash Discount Price: $988
- vs. Medicare Baseline: 4.81x 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 481% of the Medicare baseline (a markup of 381%). 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 |
|---|---|---|
| Medicaid / KanCare | $60 - $136 | 56% |
| Aetna | $75 - $1,564 | 70% |
| Humana | $76 - $125 | 71% |
| UnitedHealthcare | $90 - $514 | 84% |
| Transplants-Case Rates [5750] | $105 - $1,646 | 98% |
| Cigna | $118 - $1,249 | 110% |
| Blue Cross Blue Shield | $120 - $1,236 | 112% |
| Commercial-Contracted [8000] | $246 - $1,332 | 230% |
| First Health [5512] | $976 | 914% |
Consumer Guidance & Cost Commentary
For this ultrasound procedure at Saint Luke's South Hospital in Overland Park, Kansas, the cash price of $988 is significantly lower than the facility's gross charge of $1,646. While the hospital's negotiated rates for in-network payers like Aetna and UnitedHealthcare range from $75 to $1,564, the cash price remains the most transparent benchmark for self-pay patients. It is important to note that cash payments can sometimes be cheaper than insurance claims for patients with high-deductible plans, as the negotiated rates often exceed the cash price due to administrative overhead and contract dynamics. Additionally, the facility offers a prompt-pay discount for upfront payments, which can further reduce the final amount owed compared to the standard cash rate.
When evaluating the cost relative to national standards, the Medicare benchmark for this service is $106.81, indicating that the cash price represents a substantial markup above the federal baseline. The facility's rating of 4 out of 5 reflects its standing in the acute care hospital sector. Patients should be aware that while the No Surprises Act protects against balance billing for emergency care at in-network facilities, unexpected ancillary services or out-of-network providers could still result in additional charges if not properly managed. To ensure the most accurate pricing, consumers are encouraged to request an itemized bill before payment and verify their specific plan's deductible status, as paying the full negotiated rate without meeting a deductible can result in higher out-of-pocket costs than paying the cash price directly.