Ultrasound, pelvis
Facility: Ashland Health Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $171
- Cash Discount Price: $137
- vs. Medicare Baseline: 1.60x 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 |
|---|---|---|
| Blue Cross Blue Shield | $57 | 53% |
| Compalliance-All Plans | $137 | 128% |
| Health Partners Of Kansas-All Plans | $145 | 136% |
| Multiplan-All Plans | $168 | 157% |
| Aetna | $171 | 160% |
| Health Choice-All Plans | $171 | 160% |
| Healthy Blue Mcr Adv - All Other Plans | $171 | 160% |
| UnitedHealthcare | $171 | 160% |
| Medicare (plans) | $171 | 160% |
| Medica Mcare - All Plans | $171 | 160% |
| Medicaid / KanCare | $171 | 160% |
| Providers Care (Wppa)-All Plans | $256 | 240% |
Consumer Guidance & Cost Commentary
For the pelvic ultrasound service at Ashland Health Center, the facility's negotiated rates across all major payers, including Blue Cross Blue Shield and UnitedHealthcare, are set at $171.00, which matches the facility's median paid amount. This rate is notably higher than the cash median of $137.00, illustrating a common scenario where paying out-of-pocket directly can be more cost-effective than using insurance, especially for patients with high deductibles. While the facility is a Critical Access Hospital in Ashland, KS, the data provided does not include specific state or county average comparisons for this procedure, so patients should verify local pricing benchmarks directly with the hospital or their insurance carrier to understand how this rate stacks up against regional norms.
Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it does not automatically eliminate all potential costs if ancillary services are billed separately. To ensure you are paying the lowest possible amount, it is advisable to request a full itemized bill before finalizing payment, as summary invoices often obscure individual charges that could be disputed. Additionally, since the cash price is lower than the negotiated rate, you may qualify for a prompt-pay discount if you settle the bill upfront; however, you must explicitly request self-pay classification and sign a waiver of insurance submission to prevent the hospital from submitting a claim that would void any cash savings.