Ultrasound, pelvis
Facility: Ellinwood District Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $133
- Cash Discount Price: $162
- vs. Medicare Baseline: 1.25x 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 |
|---|---|---|
| Cigna | $133 | 125% |
| Aetna | $133 | 125% |
| Blue Cross Blue Shield | $133 | 125% |
| UnitedHealthcare | $133 | 125% |
| Humana | $133 | 125% |
Consumer Guidance & Cost Commentary
For the ultrasound of the pelvis at Ellinwood District Hospital, the negotiated rate for in-network payers is $133, which matches the cash median of $162.00. This suggests that paying out-of-pocket directly may be more cost-effective than using insurance, as the cash price is lower than the amount insurers are contractually obligated to pay. While the facility is a Critical Access Hospital in Ellinwood, KS, with a government ownership structure, patients should verify their specific plan details before scheduling. If you have a high-deductible plan, paying the cash price of $162.00 upfront could save you money compared to the $133.00 allowed amount, provided your deductible has not yet been met.
Before finalizing any payment, it is important to request a prompt-pay discount from the hospital, which can reduce the cash price by 20% to 50%. Additionally, if you receive a bill from an out-of-network provider or for services like emergency care at an in-network facility, you may be protected by the No Surprises Act, which bans balance billing for these scenarios. If you do receive a surprise bill, do not pay it immediately; instead, dispute the charge in writing with the insurer and request a formal audit to ensure the billing complies with federal protections. Always demand a full itemized bill showing specific CPT codes before agreeing to any payment plan or settlement.