Ultrasound, pelvis
Facility: Kansas City Orthopaedic Institute
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $254
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.38x 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 238% of the Medicare baseline (a markup of 138%). 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 |
|---|---|---|
| Aetna | $98 | 92% |
| UnitedHealthcare | $98 | 92% |
| Cigna | $100 | 94% |
| Blue Cross Blue Shield | $254 | 238% |
Consumer Guidance & Cost Commentary
This ultrasound procedure at Kansas City Orthopaedic Institute in Leawood, KS, has a negotiated rate of $254.00, which is significantly higher than the state average of $106.81. While commercial insurance contracts often result in higher prices due to administrative costs and claim processing fees, patients with high-deductible plans might find that paying cash directly is more cost-effective, as the cash price can sometimes be lower than the insurance negotiated rate. It is important to verify your specific plan's deductible status before scheduling, as paying out-of-pocket may save money if your insurance has not yet covered your expenses.
For patients choosing to pay directly, ask the facility about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if settled upfront. If you are using insurance, be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act; however, unexpected charges may still occur if ancillary services like labs are provided by out-of-network providers. To ensure accuracy, always request a full itemized bill before paying, as summary invoices can hide errors or unbundled charges that should not be billed separately.