Ultrasound, pelvis
Facility: Stormont Vail Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $96
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.90x 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 |
|---|---|---|
| UnitedHealthcare | $61 - $93 | 57% |
| Ambetter / Centene | $61 - $93 | 57% |
| Blue Cross Blue Shield | $62 - $959 | 58% |
| Aetna | $96 - $98 | 90% |
| Humana | $96 - $98 | 90% |
Consumer Guidance & Cost Commentary
For the CPT code 76856 (Ultrasound, pelvis) at Stormont Vail Hospital in Topeka, KS, the Medicare benchmark rate is $106.81, which serves as the objective baseline for evaluating pricing fairness. While the facility's median negotiated rate is $96.00, this figure represents the average amount commercial payers like UnitedHealthcare and Aetna agree to pay under their specific contracts, not the lowest possible price for a patient. It is important to note that cash-pay options are not listed in this report, meaning patients without insurance coverage may not be able to access the potential savings of self-pay rates, which can sometimes be lower than negotiated commercial rates. Additionally, while the facility is a voluntary non-profit with a high rating, the wide variation in negotiated rates across different payers—ranging from a low of 61% to a high of 959% of the Medicare rate—highlights that in-network status does not guarantee a uniform price, and patients should verify their specific plan's allowed amount before scheduling.
To minimize out-of-pocket costs, patients should proactively inquire about "prompt-pay" discounts, which are fee reductions typically offered for upfront payment and can range from 20% to 50% off the billed amount. These discounts bypass the administrative overhead of insurance claims processing and provide immediate liquidity to the hospital, often resulting in a lower final bill than the standard negotiated rate. Furthermore, if a patient receives an itemized bill, they should request a full line-by-line audit to identify any errors, double-billing, or unbundled codes, as over 80% of hospital bills contain inaccuracies