Ultrasound, pelvis
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $176
- Cash Discount Price: $554
- vs. Medicare Baseline: 1.65x 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 | $40 - $102 | 37% |
| Blue Cross Blue Shield | $60 - $102 | 56% |
| Humana | $61 - $104 | 57% |
| Aetna | $61 - $102 | 57% |
| Provider Partners Health Plans Contracted [320450] | $65 | 61% |
| First Health Contracted [320128] | $69 | 65% |
| UnitedHealthcare | $91 - $788 | 85% |
| Elara Caring Aspire Hospice [20433] | $102 | 95% |
| Medical Associates Health Contracted [320444] | $102 | 95% |
| Cross Timbers Hospice [20098] | $102 | 95% |
| Halo Hcr Inc Hospice [20432] | $102 | 95% |
| Mercy Hospice Okc [20252] | $102 | 95% |
| Qual Choice Contracted [320325] | $102 | 95% |
| Kindful Hospice Contracted [320434] | $102 | 95% |
| Halo Hcr Inc Hospice Contracted [320432] | $102 | 95% |
| Tricare | $102 | 95% |
| Mercy Mgd Behavioral Health Contracted [320259] | $102 | 95% |
| Kindful Hospice [20434] | $102 | 95% |
| Globalhealth Contracted [320145] | $102 | 95% |
| Pace Of The Ozarks Contracted [320518] | $102 | 95% |
| Cherokee Nation Health Serv Contracted [320066] | $102 | 95% |
| Medicare (plans) | $102 | 95% |
| Cigna | $102 - $467 | 95% |
| Centivo Contracted [320505] | $104 | 97% |
| Dept Of Veteran Affairs Contracted [320106] | $104 | 97% |
| United Medical Resources Contracted [320454] | $155 - $295 | 145% |
| Providrs Care Network Contracted [320484] | $197 | 184% |
| Benefit Management Contracted [320052] | $295 | 276% |
| Healthscope Contracted [320182] | $295 - $639 | 276% |
| Health Systems Inc Contracted [320174] | $295 | 276% |
| Point C Contracted [320238] | $295 - $639 | 276% |
| Insurance System Inc Contracted [320465] | $295 | 276% |
| Medica Contracted [320239] | $310 | 290% |
| Show-Me Health Administrators Contracted [320483] | $389 | 364% |
| Mercy Benefit Admin Contracted [320251] | $389 - $596 | 364% |
| Aither Health Contracted [320449] | $596 | 558% |
| Ebms Contracted [320493] | $596 | 558% |
| American Healthcare Alliance Contracted [320020] | $596 | 558% |
| Reflect Health Contracted [320492] | $596 | 558% |
| Edison Health Solutions Contracted [320502] | $596 | 558% |
| Imagine 360 Contracted [320494] | $596 | 558% |
| Yuzu Health Contracted [320521] | $596 | 558% |
| Auxiant Contracted [320462] | $596 - $639 | 558% |
| Preferred Health Plan Contracted [320522] | $639 | 598% |
| Healthlink Contracted [320179] | $639 | 598% |
| Federal Medical Center Contracted [320127] | $639 | 598% |
| Compcare Of The Ozarks Contracted [320437] | $673 | 630% |
| Workers Comp [20426] | $682 | 639% |
| Private Health Care Systems Contracted [320320] | $788 | 738% |
| Multiplan [20270] | $809 | 757% |
| Multiplan Contracted [320270] | $809 | 757% |
Consumer Guidance & Cost Commentary
For the ultrasound of the pelvis (CPT 76856) at Mercy Specialty Hospital Southeast Kansas, the facility's cash price of $554.00 is significantly lower than the gross charge of $852.00, offering a potential savings for patients with high-deductible plans who may not have insurance coverage. While the facility's cash rate is higher than the state average of $554.00, it remains well below the gross charges and the negotiated rates paid by major payers like UnitedHealthcare, which range from $91 to $788 depending on the plan. Patients should verify their specific insurance coverage, as many commercial plans negotiate rates between $60 and $389 for this service, which can be lower than the cash price if the patient's deductible has not yet been met. It is also important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still confirm their network status to avoid unexpected costs.
To ensure you receive the most accurate and fair billing, we recommend requesting a full itemized bill that details every CPT code and service rendered, as summary bills often obscure errors or unbundled charges. If you are paying out-of-pocket, ask the billing department about prompt-pay discounts, which can reduce the $554.00 cash price by 20% to 50% if settled within 30 days. Additionally, compare the facility's negotiated rates against the Medicare benchmark of $106.81; commercial rates for this procedure typically range from 1.6 times the Medicare amount up to 6 times that figure