Ultrasound, pelvis
Facility: Lane County Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $425
- Cash Discount Price: $425
- vs. Medicare Baseline: 3.98x 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 398% of the Medicare baseline (a markup of 298%). 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 |
|---|---|---|
| Aetna | $382 - $404 | 358% |
| UnitedHealthcare | $382 - $425 | 358% |
| Medicaid / KanCare | $425 - $468 | 398% |
| Healthy Blue Mcaid | $425 | 398% |
| Healthy Blue Mcr Adv - All Other Plans | $425 | 398% |
| Wppa Providers-All Plans | $638 | 597% |
Consumer Guidance & Cost Commentary
For the pelvic ultrasound procedure (CPT 76856) at Lane County Hospital in Dighton, KS, the cash price is $425.00, which matches the facility's median negotiated rate and the state average. This service is billed under the Critical Access Hospital designation, and the facility is owned by a Government Hospital District. While commercial payers like Aetna and UnitedHealthcare negotiate rates ranging from $382 to $468, these amounts are generally higher than the cash price. For patients with high-deductible plans, paying the $425 cash rate directly may be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price.
The Medicare benchmark for this service is $106.81, indicating that the facility's cash and negotiated rates represent a significant markup above the federal baseline. To minimize costs, patients should explicitly request a self-pay or prompt-pay discount before scheduling, as these programs can reduce the final bill by 20% to 50%. It is also important to avoid accepting summary bills; instead, patients should demand a full itemized statement to verify that no unbundled codes or services not rendered are included. If a balance bill arises from out-of-network ancillary services, the No Surprises Act provides protections against unexpected charges for emergency care and non-emergency services at in-network facilities.