Ultrasound, pelvis
Facility: Wesley Medical Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $595
- Cash Discount Price: $3,441
- vs. Medicare Baseline: 5.57x 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 557% of the Medicare baseline (a markup of 457%). 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 |
|---|---|---|
| UnitedHealthcare | $60 | 56% |
| Medicaid / KanCare | $62 | 58% |
| Amerigroup | $62 | 58% |
| Aetna | $62 - $1,228 | 58% |
| First Health | $119 - $1,586 | 111% |
| Blue Cross Blue Shield | $123 | 115% |
| Multiplan | $124 - $3,097 | 116% |
| United | $245 - $1,548 | 229% |
| Health Partners Of Kansas | $595 - $1,720 | 557% |
| Wppa | $599 | 561% |
| Ambetter / Centene | $619 | 580% |
| Medical Associates Health Plan | $650 | 609% |
| Preferred Health Choices | $650 | 609% |
| Spirit Aerosystems | $1,101 | 1031% |
| Triwest Healthcare Alliance | $2,237 | 2094% |
| Usa Managed Care | $2,925 | 2739% |
Consumer Guidance & Cost Commentary
For the pelvic ultrasound procedure (CPT 76856) at Wesley Medical Center in Wichita, KS, the cash price is $3,441.00, which matches the facility's median paid amount. This cash rate is significantly higher than the state average, as indicated by a 5.6x multiplier relative to Medicare benchmarks. While commercial insurance plans like Aetna and Multiplan have negotiated rates ranging from $60 to over $3,000 depending on the specific plan, these negotiated amounts often exceed the cash price for patients with high-deductible plans. In such cases, paying the cash rate directly can be more cost-effective than relying on insurance, provided the patient has not yet met their deductible. Patients should verify their specific plan's allowed amount before scheduling, as some in-network contracts may result in higher out-of-pocket costs than the cash price.
To minimize potential billing errors, patients should request a full itemized bill before finalizing payment, as summary invoices often obscure individual charges or unbundled components. If a balance bill arises from out-of-network ancillary services, the No Surprises Act may protect patients from paying the difference for emergency or non-emergency care at in-network facilities. Additionally, patients can often reduce their final cost by asking the billing department about prompt-pay discounts, which typically offer a fee reduction for upfront payment. Given that the facility is a proprietary acute care hospital, it is advisable to contact them directly to confirm self-pay or prompt-pay rates prior to check-in, ensuring you are not automatically enrolled in a billing cycle that includes administrative overhead.