CMS Price Transparency Data

Ultrasound, pelvis

Facility: Kenmore Mercy Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76856
  • Insurance Median: $76
  • Cash Discount Price: $99
  • vs. Medicare Baseline: 0.71x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at Kenmore Mercy Hospital is $76. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $99. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.71x the Medicare baseline. Located in 2950 Elmwood Avenue, Kenmore, NY.
Cash / Self-Pay
$99

Average discount available for prompt cash payment at this facility.

Insurance Median
$76

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: $99 (93%)
Insurance Median: $76 (71%)
Cash: $99 (93% of Medicare)
Ins. Median: $76 (71% 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.

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 $22 - $103 21%
Medicaid / KanCare $26 - $115 24%
Blue Cross Blue Shield $26 - $154 24%
VA Veterans Affairs [700001] $27 - $86 25%
Univera Healthcare [100169] $28 - $124 26%
Beacon Essential [350122] $28 - $121 26%
Univera Healthcare Essential [100170] $28 - $88 26%
Excellus Rochester McD [350117] $29 - $81 27%
Independent Health Essential [100166] $29 - $138 27%
Tuscarora Nation [550120] $29 - $81 27%
Crime Victims [100176] $29 - $81 27%
Vna Option Mltc [350110] $29 - $81 27%
Ghi [100153] $30 - $96 28%
Catholic Health Life Pace [400005] $31 - $101 29%
Fallon Health [450115] $31 - $101 29%
Hospice [550001] $31 - $101 29%
Medicare (plans) $31 - $167 29%
Champ VA [700002] $31 - $101 29%
Tricare $31 - $101 29%
Covid19 Hrsa [45013] $31 - $101 29%
Seneca Nation [450119] $31 - $101 29%
Cigna $31 - $146 29%
Aetna $33 - $106 31%
Fidelis Dual Advantage [450120] $33 - $106 31%
Humana $33 - $106 31%
Wellcare Fidelis Dual [450451] $33 - $106 31%
Iha First Choice [800001] $34 - $277 32%
Wellcare [450129] $34 - $111 32%
Independent Health [100165] $34 - $276 32%
Fidelis Essential [100163] $34 - $125 32%
Beacon Health Options [100023] $38 - $121 36%
Fidelis Exchange [100164] $38 - $121 36%
Mvp Healthcare [100168] $43 - $133 40%
Amerigroup [350102] $49 - $154 46%
UPMC Health Plan [100181] $56 - $181 52%
Molina Essential [100167] $65 - $181 61%
Federal Workers Compensation [500100] $94 - $209 88%
No Fault [114001] $94 - $209 88%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 2950 Elmwood Avenue, Kenmore, NY 14217
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals