CMS Price Transparency Data

Ultrasound, pelvis

Facility: Mercy Hospital Joplin

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $370
Cash Discount Price: $701
vs. Medicare Baseline: 3.46x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Mercy Hospital Joplin is $370. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $701. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.46x the Medicare baseline. Located in 100 Mercy Way, Joplin, MO.

Cash / Self-Pay

$701

Average discount available for prompt cash payment at this facility.

Insurance Median

$370

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $701 (656%)

Insurance Median: $370 (346%)

Cash: $701 (656% of Medicare)

Ins. Median: $370 (346% of 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 346% of the Medicare baseline (a markup of 246%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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 - $163	37%
Blue Cross Blue Shield	$59 - $787	55%
Indian Health Service Contracted [320198]	$59 - $701	55%
Aetna	$61 - $107	57%
Humana	$61 - $324	57%
Champva [20065]	$95	89%
Cherokee Nation Health Serv Contracted [320066]	$95	89%
Cigna	$95 - $467	89%
Cross Timbers Hospice [20098]	$95	89%
Dept Of Veteran Affairs Contracted [320106]	$95	89%
Elara Caring Aspire Hospice [20433]	$95	89%
Globalhealth Contracted [320145]	$95	89%
Halo Hcr Inc Hospice Contracted [320432]	$95	89%
Halo Hcr Inc Hospice [20432]	$95	89%
Kindful Hospice Contracted [320434]	$95	89%
Kindful Hospice [20434]	$95	89%
Medicare (plans)	$95 - $100	89%
Mercy Hospice Okc [20252]	$95	89%
Mercy Mgd Behavioral Health Contracted [320259]	$95	89%
Pace Of The Ozarks Contracted [320518]	$95	89%
Provider Partners Health Plans Contracted [320450]	$95	89%
Qual Choice Contracted [320325]	$95	89%
Tricare	$95	89%
UnitedHealthcare	$95 - $245	89%
Centivo Contracted [320505]	$97	91%
Healthscope Contracted [320182]	$121	113%
Ambetter / Centene	$163	153%
Home State Health Plan Contracted [320187]	$163	153%
Novasys Contracted [320285]	$163	153%
Providrs Care Network Contracted [320484]	$197	184%
Health Choice Contracted [320166]	$213	199%
United Medical Resources Contracted [320454]	$241 - $245	226%
90 Degree Benefits Contracted [320436]	$370	346%
Mercy Benefit Admin Contracted [320251]	$370 - $615	346%
Show-Me Health Administrators Contracted [320483]	$370 - $389	346%
Point C Contracted [320238]	$378 - $863	354%
Medica Contracted [320239]	$393	368%
Healthlink Contracted [320179]	$459 - $701	430%
Benefit Management Contracted [320052]	$464	434%
Health Systems Inc Contracted [320174]	$464	434%
Insurance System Inc Contracted [320465]	$464	434%
Administrative Payor Contracted [320005]	$486	455%
Aither Health Contracted [320449]	$615	576%
Auxiant Contracted [320462]	$615 - $701	576%
Ebms Contracted [320493]	$615	576%
Edison Health Solutions Contracted [320502]	$615	576%
Imagine 360 Contracted [320494]	$615	576%
Reflect Health Contracted [320492]	$615	576%
Yuzu Health Contracted [320521]	$615	576%
Preferred Health Plan Contracted [320522]	$701	656%
First Health Contracted [320128]	$735	688%
American Healthcare Alliance Contracted [320020]	$755	707%
Multiplan Contracted [320270]	$831	778%
Private Health Care Systems Contracted [320320]	$831	778%
Usable Contracted [320409]	$831	778%
Point C [20238]	$863	808%
Workers Comp [20426]	$863 - $1,079	808%
Usa Managed Care Org Contracted [320429]	$950	889%
Ppo Plus Contracted [320310]	$971	909%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $701.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 76856.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercy Hospital Joplin is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 76856.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.