Ultrasound, pelvis
Facility: Kansas Heart Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $147
- Cash Discount Price: $151
- vs. Medicare Baseline: 1.38x 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 |
|---|---|---|
| Tricare | $87 | 81% |
| Humana | $96 | 90% |
| UnitedHealthcare | $96 - $240 | 90% |
| Wppa - All Plans | $96 | 90% |
| Medicaid / KanCare | $96 - $240 | 90% |
| Celtic Mcr Adv | $96 | 90% |
| Blue Cross Blue Shield | $100 - $240 | 94% |
| Multiplan - All Plans | $216 | 202% |
| Aetna | $234 - $240 | 219% |
| Celtic Mcaid - All Other Plans | $240 | 225% |
| Soonerselect Mcaid - All Plans | $240 | 225% |
Consumer Guidance & Cost Commentary
For this ultrasound procedure at Kansas Heart Hospital in Wichita, KS, the facility's cash price of $151.00 is lower than the state average of $156.00, making it a competitive option for self-pay patients. While the hospital's gross charge is $240.00, commercial payers negotiate rates ranging from $87 to $240 depending on the specific plan, with some carriers like Tricare and Humana paying the full gross amount. Because insurance negotiated rates can sometimes exceed the cash price, patients with high-deductible plans may find it financially beneficial to pay the cash rate directly, provided they secure a prompt-pay discount before scheduling. It is important to request self-pay classification and a prompt-pay discount upfront to avoid automatic claim submission, which could void the lower cash agreement and trigger administrative fees.
The facility's pricing is benchmarked against Medicare, which sets a fixed rate of $106.81 for this service. The hospital's cash rate of $151.00 represents a markup of 1.4 times the Medicare amount, which falls within the typical range of 120% to 150% considered fair for commercial pricing. Although the facility is an in-network provider for many carriers, patients should be aware that balance billing is generally prohibited for in-network services under federal law, meaning they would not be responsible for the difference between the negotiated rate and the gross charge. To ensure accuracy, patients should always request a detailed, itemized bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered.