Ultrasound, pelvis
Facility: Mercy Hospital Columbus
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $602
- Cash Discount Price: $539
- vs. Medicare Baseline: 5.64x 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 564% of the Medicare baseline (a markup of 464%). 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 | $61 - $602 | 57% |
| Humana | $61 - $788 | 57% |
| Blue Cross Blue Shield | $91 - $602 | 85% |
| UnitedHealthcare | $91 - $688 | 85% |
| Medicare (plans) | $100 - $626 | 94% |
| Health Systems Inc Contracted [320174] | $356 | 333% |
| Insurance System Inc Contracted [320465] | $356 | 333% |
| Administrative Payor Contracted [320005] | $373 | 349% |
| Mercy Hospice Okc [20252] | $602 | 564% |
| Medical Associates Health Contracted [320444] | $602 | 564% |
| Pace Of The Ozarks Contracted [320518] | $602 | 564% |
| Halo Hcr Inc Hospice Contracted [320432] | $602 | 564% |
| Elara Caring Aspire Hospice [20433] | $602 | 564% |
| Globalhealth Contracted [320145] | $602 | 564% |
| Cigna | $602 | 564% |
| Mercy Mgd Behavioral Health Contracted [320259] | $602 | 564% |
| Halo Hcr Inc Hospice [20432] | $602 | 564% |
| Indian Health Service Contracted [320198] | $602 | 564% |
| Aetna | $602 - $746 | 564% |
| Dept Of Veteran Affairs Contracted [320106] | $602 | 564% |
| Cherokee Nation Health Serv Contracted [320066] | $602 | 564% |
| Home State Health Plan Contracted [320187] | $602 | 564% |
| Cross Timbers Hospice [20098] | $602 | 564% |
| Kindful Hospice [20434] | $602 | 564% |
| Centurion Of Missouri [20459] | $602 | 564% |
| Kindful Hospice Contracted [320434] | $602 | 564% |
| Ambetter / Centene | $602 | 564% |
| Provider Partners Health Plans Contracted [320450] | $602 | 564% |
| Qual Choice Contracted [320325] | $602 | 564% |
| Novasys Contracted [320285] | $602 | 564% |
| Tricare | $604 | 565% |
| Healthscope Contracted [320182] | $639 | 598% |
| Workers Comp [20426] | $663 - $705 | 621% |
| United Medical Resources Contracted [320454] | $688 - $788 | 644% |
| Medica Contracted [320239] | $743 | 696% |
| Federal Medical Center Contracted [320127] | $746 | 698% |
| Preferred Health Plan Contracted [320522] | $746 | 698% |
| First Health Contracted [320128] | $746 | 698% |
| Mercy Benefit Admin Contracted [320251] | $746 - $788 | 698% |
| Healthlink Contracted [320179] | $746 - $788 | 698% |
| American Healthcare Alliance Contracted [320020] | $746 | 698% |
| Usa Managed Care Org Contracted [320429] | $746 | 698% |
| Point C Contracted [320238] | $788 | 738% |
| Reflect Health Contracted [320492] | $788 | 738% |
| Benefit Management Contracted [320052] | $788 | 738% |
| Imagine 360 Contracted [320494] | $788 | 738% |
| Ebms Contracted [320493] | $788 | 738% |
| Auxiant Contracted [320462] | $788 | 738% |
| Aither Health Contracted [320449] | $788 | 738% |
| Ppo Plus Contracted [320310] | $788 | 738% |
| Show-Me Health Administrators Contracted [320483] | $788 | 738% |
| Edison Health Solutions Contracted [320502] | $788 | 738% |
| 90 Degree Benefits Contracted [320436] | $788 | 738% |
| Private Health Care Systems Contracted [320320] | $788 | 738% |
| Yuzu Health Contracted [320521] | $788 | 738% |
Consumer Guidance & Cost Commentary
For the ultrasound of the pelvis (CPT 76856) at Mercy Hospital Columbus, the facility's cash price of $539.00 is notably lower than the median negotiated rate of $602.00 and the gross charge of $829.00. While the facility is a Critical Access Hospital in Kansas, the data does not provide specific county or state average figures for this procedure, so a direct comparison to regional averages is not possible. However, the cash price is significantly lower than the Medicare benchmark of $106.81 adjusted for local costs, which typically serves as the objective baseline for evaluating hospital pricing markups. Patients with high-deductible plans may find that paying the cash price upfront is more cost-effective than using insurance, as the negotiated rate often exceeds the cash price, and hospitals frequently offer prompt-pay discounts for self-pay patients who settle their bill immediately.
Commercial insurance payers have established contractually agreed-upon rates for this service, with negotiated amounts ranging from $61 to $788 depending on the specific plan and payer. The lowest negotiated rate of $61 is associated with Medicaid/KanCare, while the highest reaches $788 for several commercial carriers. Because these rates are set by contract, they often include administrative overhead and do not reflect the true cost of care, which is better represented by the Medicare benchmark. Patients should verify their specific plan's allowed amount before scheduling, as in-network rates vary widely among carriers. If you are self-pay, it is advisable to request a formal itemized bill to ensure no errors exist and to confirm if any prompt-pay discounts are available, as these can significantly reduce the final amount