Ultrasound, pelvis
Facility: Children'S Mercy South
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $73
- Cash Discount Price: $404
- vs. Medicare Baseline: 0.68x 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 |
|---|---|---|
| UnitedHealthcare | $28 - $1,066 | 26% |
| Medicaid / KanCare | $30 - $70 | 28% |
| Healthy Blue | $30 - $273 | 28% |
| Cigna | $31 - $1,102 | 29% |
| Home State Health | $31 - $240 | 29% |
| Wppa Providrs Care | $42 - $1,031 | 39% |
| Healthlink | $42 - $1,396 | 39% |
| Health Midwest Comprehensive Care | $45 - $1,032 | 42% |
| American Healthcare Alliance | $46 - $1,348 | 43% |
| Quiktrip | $48 - $1,032 | 45% |
| Blue Cross Blue Shield | $50 - $1,174 | 47% |
| Medica | $57 - $925 | 53% |
| Multiplan | $61 - $1,205 | 57% |
| Wellfit/Centrus | $62 - $1,031 | 58% |
| Aetna | $62 - $1,078 | 58% |
| Orscheln | $63 - $1,031 | 59% |
| Humana | $63 - $1,055 | 59% |
| Nebraska Furniture Mart | $64 - $1,031 | 60% |
| Centivo | $64 - $1,031 | 60% |
| Mercy Health | $72 - $1,190 | 67% |
| Coxhealth Network | $73 - $1,174 | 68% |
| Coventry Health Care Of Kansas | $78 - $1,174 | 73% |
| National Preferred Provider Network | $86 - $1,427 | 81% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure on the pelvis at Children's Mercy South in Overland Park, KS, the cash price is $404.00, which is significantly lower than the facility's gross charge of $842.00. While many insurance plans negotiate rates ranging from $28 to $1,427 depending on the carrier, the cash rate is notably lower than the median negotiated rate of $73.00 reported for this service. Patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the $404.00 cost is often lower than the amount an insurance plan would allow after applying its negotiated rate. To secure this lower price, patients should explicitly request a "self-pay" classification and inquire about prompt-pay discounts before scheduling, ensuring the billing system does not automatically submit a claim to their insurance provider.
The facility's pricing is benchmarked against the Medicare rate of $106.81, which serves as a federal cost baseline for healthcare delivery. The cash price of $404.00 represents a markup of approximately 377% over the Medicare amount, while the median negotiated rate of $73.00 is roughly 68% of the Medicare rate, indicating significant variation in how different payers contract with the hospital. It is 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 verify their specific plan details and deductible status before relying on insurance coverage. For the most accurate pricing, consumers are encouraged to contact the hospital directly to confirm current self-pay rates and any available prompt-pay incentives prior to receiving