Ultrasound, pelvis
Facility: Pratt Regional Medical Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $197
- Cash Discount Price: $426
- vs. Medicare Baseline: 1.84x 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 |
|---|---|---|
| Celtic Insurance Company | $102 | 95% |
| Healthy Blue | $105 | 98% |
| UnitedHealthcare | $112 - $1,038 | 105% |
| Christian Health Aid | $148 - $764 | 139% |
| Health Partners Of Kansas | $167 - $865 | 156% |
| Aetna | $177 - $916 | 166% |
| Choicecare | $197 - $1,018 | 184% |
Consumer Guidance & Cost Commentary
For the pelvic ultrasound procedure at Pratt Regional Medical Center in Pratt, KS, the cash median price is $426.00, which is significantly lower than the facility's negotiated rates with major payers like UnitedHealthcare (ranging from $112 to $1,038) and Aetna (ranging from $177 to $916). This price difference highlights a common billing dynamic where commercial insurance contracts often result in higher out-of-pocket costs for patients than paying cash directly, especially if their insurance deductible has not yet been met. While the facility's cash rate is notably lower than its gross charge of $608.00, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront incentives can further reduce the final amount owed.
When evaluating the cost relative to federal standards, the facility's Medicare benchmark amount of $106.81 serves as the most reliable baseline for understanding true pricing. The cash price of $426.00 represents a markup of 1.8 times the Medicare rate, which falls within the typical range for commercial pricing structures that include administrative overhead and risk adjustments. Because over 80% of hospital bills contain errors, patients should request a detailed, itemized statement rather than accepting a summary bill, ensuring that charges for services not rendered or unbundled components are identified. If a balance bill arises from an out-of-network ancillary service, the No Surprises Act may provide protection, and patients should be prepared to dispute any unexpected charges in writing rather than paying immediately out of fear.