Ultrasound, pelvis
Facility: Lmh
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $107
- Cash Discount Price: $333
- vs. Medicare Baseline: 1.00x 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 |
|---|---|---|
| Blue Cross Blue Shield | $61 - $861 | 57% |
| UnitedHealthcare | $61 - $884 | 57% |
| Cigna | $105 - $889 | 98% |
| Medicare (plans) | $105 | 98% |
| Humana | $105 | 98% |
| Haskell Indian Health Services | $105 | 98% |
| Allwell | $107 | 100% |
| Ambetter / Centene | $163 | 153% |
| Aetna | $848 - $1,105 | 794% |
| Non Contracted | $1,065 | 997% |
| First Health | $1,238 | 1159% |
Consumer Guidance & Cost Commentary
For this ultrasound procedure in Lawrence, KS, the facility's cash price of $333.00 is significantly lower than the negotiated rates charged by major insurers like Blue Cross Blue Shield ($61–$861) and UnitedHealthcare ($61–$884). Because commercial insurance contracts often include administrative overhead and risk premiums, the cash rate can be a more affordable option for patients with high-deductible plans or those without insurance. While the facility is a government-owned acute care hospital with a strong 4-star rating, patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the final cost by bypassing the costly insurance claims cycle.
It is important to understand that the gross charge of $1,332.00 is not the amount you will pay; commercial payers are contractually bound to pay only their negotiated maximums, which still exceed the cash price. Furthermore, Medicare serves as a reliable benchmark for fair pricing, with this service's allowed amount of $106.81 representing the true cost baseline. If you receive a bill that exceeds the cash price or the Medicare rate, you may be facing balance billing from out-of-network ancillary services or errors in the itemized statement. To protect yourself, always request a full, line-by-line itemized bill before paying and dispute any charges that do not match the service rendered or the negotiated rate.