Ultrasound, pelvis
Facility: Rawlins County Health Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $270
- Cash Discount Price: $264
- vs. Medicare Baseline: 2.53x 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 253% of the Medicare baseline (a markup of 153%). 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 | $123 | 115% |
| UnitedHealthcare | $270 | 253% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure on the pelvis at Rawlins County Health Center in Atwood, Kansas, the cash price is $264.00, which is lower than the facility's negotiated rates of $270.00 and the state average of $270.00. While Blue Cross Blue Shield and UnitedHealthcare have negotiated rates of $123.00 and $270.00 respectively, patients with high-deductible plans may find paying cash directly more affordable if their insurance allowed amount exceeds the cash price. Because the cash rate is already below the negotiated average, there is no immediate financial advantage to using insurance for this specific service, though patients should always verify their specific plan's deductible status before scheduling.
This facility, a Critical Access Hospital, bills Medicare at a rate of $106.81, which is significantly lower than the cash price of $264.00, indicating a substantial markup relative to the federal benchmark. If you choose to pay out of network, you could face balance billing for the difference between the provider's full charge and what your insurer allows, though the No Surprises Act protects you from such surprise bills for emergency care and non-emergency services at in-network facilities. To ensure you receive the lowest possible price, we recommend requesting a prompt-pay discount or self-pay rate before your visit, as these upfront discounts can bypass administrative fees and reduce your total cost. Always ask for an itemized bill to confirm that no services were unbundled or double-charged, as over 80% of hospital bills contain errors that can be corrected through a formal audit.