CMS Price Transparency Data

Ultrasound, pelvis

Facility: The Children's Mercy Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $73
Cash Discount Price: $404
vs. Medicare Baseline: 0.68x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at The Children's Mercy Hospital is $73. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $404. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.68x the Medicare baseline. Located in 2401 Gillham Road, Kansas City, MO.

Cash / Self-Pay

$404

Average discount available for prompt cash payment at this facility.

Insurance Median

$73

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: $404 (378%)

Insurance Median: $73 (68%)

Cash: $404 (378% of Medicare)

Ins. Median: $73 (68% 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.

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
UnitedHealthcare	$28 - $1,066	26%
Healthy Blue	$30 - $273	28%
Medicaid / KanCare	$30 - $70	28%
Cigna	$31 - $1,102	29%
Home State Health	$31 - $240	29%
Healthlink	$42 - $1,396	39%
Wppa Providrs Care	$42 - $1,031	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%
Aetna	$62 - $1,078	58%
Wellfit/Centrus	$62 - $1,031	58%
Humana	$63 - $1,055	59%
Orscheln	$63 - $1,031	59%
Centivo	$64 - $1,031	60%
Nebraska Furniture Mart	$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%

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 $404.
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 The Children's Mercy 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.