Ultrasound, pelvis
Facility: Centura St. Catherine-Dodge City
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $960
- Cash Discount Price: $583
- vs. Medicare Baseline: 8.99x 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 899% of the Medicare baseline (a markup of 799%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $63 - $145 | 59% |
| Cigna | $63 | 59% |
| Kansas Health | $63 | 59% |
| Aetna | $63 - $1,167 | 59% |
| Medicare (plans) | $63 | 59% |
| Kaiser | $63 | 59% |
| Humana | $63 | 59% |
| Centura Employee Plan | $205 | 192% |
| UnitedHealthcare | $960 | 899% |
| Wpaa | $1,021 | 956% |
| Christian Health Aid | $1,167 | 1093% |
| Multiplan | $1,167 - $1,313 | 1093% |
| Health Partners Of Kansas | $1,313 | 1229% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure (CPT 76856) at Centura St. Catherine-Dodge City in Dodge City, KS, the facility's cash median price is $583.00, which is significantly lower than the state average for this service. While many commercial payers negotiate rates that exceed the cash price—such as UnitedHealthcare and Multiplan offering rates between $960 and $1,313—patients with high-deductible plans may find paying cash directly more cost-effective than relying on insurance, as the negotiated allowed amounts often surpass the cash rate. It is important to note that while Medicare sets a benchmark of $106.81 for this code, commercial contracts frequently result in higher out-of-pocket costs for members, highlighting the gap between federal cost baselines and private market pricing.
Patients should be aware that insurance companies negotiate maximum rates to protect their members, but these contracts can sometimes lead to higher bills than direct payment. For instance, while the facility's median negotiated rate across payers is $960.00, the cash price remains lower at $583.00. To minimize costs, individuals should ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as paying upfront can bypass administrative fees and reduce the final amount owed. Additionally, if a patient receives a bill from an out-of-network provider or encounters unexpected charges, they should request an itemized audit to identify errors or unbundled codes, as summary bills often obscure the true cost of care.