CMS Price Transparency Data

Ultrasound, pelvis

Facility: Mercy St Francis Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $901
Cash Discount Price: $651
vs. Medicare Baseline: 8.44x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Mercy St Francis Hospital is $901. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $651. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.44x the Medicare baseline. Located in 100 West Highway 60, Po Box 82, Mountain View, MO.

Cash / Self-Pay

$651

Average discount available for prompt cash payment at this facility.

Insurance Median

$901

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: $651 (609%)

Insurance Median: $901 (844%)

Cash: $651 (609% of Medicare)

Ins. Median: $901 (844% 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 844% of the Medicare baseline (a markup of 744%). 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	$60 - $520	56%
Medicare (plans)	$99 - $357	93%
Blue Cross Blue Shield	$100 - $971	94%
UnitedHealthcare	$140 - $951	131%
Tricare	$340	318%
Aetna	$343 - $891	321%
Cherokee Nation Health Serv Contracted [320066]	$343	321%
Cigna	$343 - $951	321%
Cross Timbers Hospice [20098]	$343	321%
Dept Of Veteran Affairs Contracted [320106]	$343	321%
Elara Caring Aspire Hospice [20433]	$343	321%
Globalhealth Contracted [320145]	$343	321%
Halo Hcr Inc Hospice Contracted [320432]	$343	321%
Halo Hcr Inc Hospice [20432]	$343	321%
Humana	$343 - $901	321%
Indian Health Service Contracted [320198]	$343	321%
Kindful Hospice Contracted [320434]	$343	321%
Kindful Hospice [20434]	$343	321%
Medical Associates Health Contracted [320444]	$343	321%
Mercy Hospice Okc [20252]	$343	321%
Mercy Mgd Behavioral Health Contracted [320259]	$343	321%
Pace Of The Ozarks Contracted [320518]	$343	321%
Provider Partners Health Plans Contracted [320450]	$343	321%
Qual Choice Contracted [320325]	$343	321%
Administrative Payor Contracted [320005]	$450	421%
Healthscope Contracted [320182]	$456	427%
Ambetter / Centene	$520	487%
Home State Health Plan Contracted [320187]	$520	487%
Novasys Contracted [320285]	$520	487%
Centivo Contracted [320505]	$581	544%
Healthlink Contracted [320179]	$651 - $951	609%
Preferred Health Plan Contracted [320522]	$651	609%
Workers Comp [20426]	$801 - $851	750%
Auxiant Contracted [320462]	$901 - $951	844%
Mercy Benefit Admin Contracted [320251]	$901 - $951	844%
Point C Contracted [320238]	$901 - $951	844%
United Medical Resources Contracted [320454]	$901 - $931	844%
Medica Contracted [320239]	$946	886%
90 Degree Benefits Contracted [320436]	$951	890%
Aither Health Contracted [320449]	$951	890%
Benefit Management Contracted [320052]	$951	890%
Ebms Contracted [320493]	$951	890%
Edison Health Solutions Contracted [320502]	$951	890%
Evolutions Health Care Contracted [320124]	$951	890%
First Health Contracted [320128]	$951	890%
Health Systems Inc Contracted [320174]	$951	890%
Imagine 360 Contracted [320494]	$951	890%
Insurance System Inc Contracted [320465]	$951	890%
Multiplan Contracted [320270]	$951	890%
Point C [20238]	$951	890%
Private Health Care Systems Contracted [320320]	$951	890%
Reflect Health Contracted [320492]	$951	890%
Show-Me Health Administrators Contracted [320483]	$951	890%
Usa Managed Care Org Contracted [320429]	$951	890%
Yuzu Health Contracted [320521]	$951	890%

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 $651.
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 St Francis Hospital 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.