Ultrasound, pelvis
Facility: Nmc Health
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $240
- Cash Discount Price: $291
- vs. Medicare Baseline: 2.25x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 225% of the Medicare baseline (a markup of 125%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Bluestem Pace | $101 | 95% |
| Blue Cross Blue Shield | $123 | 115% |
| Medicaid / KanCare | $162 | 152% |
| Leading Age | $162 | 152% |
| Aetna | $174 | 163% |
| Wppa | $229 | 214% |
| Occunet | $250 | 234% |
| Samaritan Ministries International | $270 | 253% |
| Medincrease Health Plan | $270 | 253% |
| Prime Health Services | $312 | 292% |
| UnitedHealthcare | $374 | 350% |
| Cigna | $395 | 370% |
Consumer Guidance & Cost Commentary
For this ultrasound of the pelvis at Nmc Health in Newton, Kansas, the facility's cash price of $291.00 is notably higher than the state average of $240.00, though it remains below the gross chargemaster rate of $416.00. While commercial insurance carriers negotiate rates ranging from $101 to $395, these amounts often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash rate directly, as the insurance negotiated rates can sometimes be significantly higher than what a self-pay patient would owe. It is important to verify the specific allowed amount for your plan before scheduling, as in-network rates vary widely even within the same facility.
To minimize costs, patients should proactively inquire about "self-pay" or "prompt-pay" discounts before check-in, which can reduce the final bill by 20% to 50% by bypassing insurance claims processing. Additionally, since Medicare rates for this service are $106.81, the commercial negotiated rates represent a substantial markup compared to the federal benchmark. If you receive a bill after using insurance, request a full itemized statement to review every code and ensure no services were billed for that were not rendered or cancelled. Disputing errors in writing is the most effective way to avoid unnecessary debt, as over 80% of hospital bills contain inaccuracies that can be corrected through a formal audit.