Ultrasound, pelvis
Facility: Grisell Memorial Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $235
- Cash Discount Price: $257
- vs. Medicare Baseline: 2.20x 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 220% of the Medicare baseline (a markup of 120%). 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 | $116 | 109% |
| UnitedHealthcare | $201 - $270 | 188% |
| Humana | $270 | 253% |
| Medicaid / KanCare | $270 | 253% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure of the pelvis at Grisell Memorial Hospital in Ransom, KS, the facility's cash median rate of $257.00 is notably higher than the Medicare benchmark of $106.81, reflecting a markup of 2.2 times the federal baseline. While commercial payers like UnitedHealthcare and Humana have negotiated rates ranging from $201 to $270, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket and seeking prompt-pay discounts. It is important to note that the facility's ownership by a Government Hospital District may influence pricing structures, and patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling to ensure they are not paying the full negotiated rate when a lower cash alternative exists.
This specific CPT code is not compared against state or county averages in the provided data, so no regional benchmarking can be applied here. However, the data highlights that the facility's gross charge of $270.00 serves as the maximum potential cost before any insurance negotiation or cash discount is applied. To avoid unexpected costs, consumers should request an itemized billing audit to confirm that all charges align with the negotiated or cash rates and that no unbundled services or non-rendered items are included. Since the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should also review their specific plan details to understand their out-of-pocket maximums and deductible status before proceeding with care.