Ultrasound, pelvis
Facility: St Luke Hospital & Living Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $366
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.43x 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 343% of the Medicare baseline (a markup of 243%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $366 | 343% |
| UnitedHealthcare | $366 | 343% |
| Kansas Department Of Health And Environment | $366 | 343% |
| Bluestem Pace | $366 | 343% |
| Humana | $366 | 343% |
| Va Ccn | $366 | 343% |
| Ambetter / Centene | $369 | 345% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure on the pelvis at St Luke Hospital & Living Center in Marion, KS, the facility's negotiated rate is $366, which matches the lowest and highest amounts reported across all seven payers, including Blue Cross Blue Shield and Humana. This rate is significantly higher than the Medicare benchmark of $106.81, reflecting a markup common in commercial contracts where administrative costs and claim processing inflate the baseline price. While cash payments are not listed in the data, patients with high-deductible plans should note that paying out-of-pocket can sometimes be more cost-effective if the insurance negotiated rate exceeds the cash price, though this facility does not currently list a specific cash rate.
To ensure you receive the most accurate pricing, it is important to verify your specific plan's deductible status before scheduling, as you may be responsible for the full negotiated amount if you have not yet met your out-of-pocket threshold. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid in full upfront, bypassing the costly insurance billing cycle. If you receive a bill that includes unexpected charges or broad category summaries, request a formal itemized audit to identify errors such as unbundled codes or services not rendered, as over 80% of hospital bills contain mistakes that can be corrected through written dispute.