Ultrasound, pelvis
Facility: Wichita County Health Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $519
- Cash Discount Price: $455
- vs. Medicare Baseline: 4.86x 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 486% of the Medicare baseline (a markup of 386%). 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 |
|---|---|---|
| Medicaid / KanCare | $469 | 439% |
| UnitedHealthcare | $569 | 533% |
Consumer Guidance & Cost Commentary
For the pelvic ultrasound procedure (CPT 76856) at Wichita County Health Center in Leoti, Kansas, the facility's cash median price of $455.00 is notably lower than the state average of $519.00 and the county average of $569.00. While Medicaid / KanCare members pay the full negotiated rate of $469.00 due to a single plan contract, UnitedHealthcare members pay the same amount. For patients with high-deductible plans or those without insurance, paying the cash price of $455.00 directly can be more cost-effective than relying on insurance, as the negotiated rate of $519.00 exceeds the cash price. It is important to verify your specific plan's deductible status before scheduling, as paying the full negotiated rate may not be covered until that threshold is met.
To ensure you are receiving the best possible rate, we recommend asking the facility about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is still wise to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. By comparing the facility's cash rate against the Medicare benchmark of $106.81, you can see that the commercial pricing reflects standard market dynamics rather than an inflated chargemaster, but confirming the exact breakdown of your specific bill remains the most effective way to avoid unexpected costs