Ultrasound, pelvis
Facility: Rooks County Health Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $631
- Cash Discount Price: $526
- vs. Medicare Baseline: 5.91x 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 591% of the Medicare baseline (a markup of 491%). 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 | $133 | 125% |
| Celtic Mcr Adv | $329 | 308% |
| Tricare | $329 | 308% |
| Veterans Admin - All Plans | $329 | 308% |
| Celtic Comm - All Other Plans | $362 | 339% |
| Preferred Benefits Admin | $631 | 591% |
| UnitedHealthcare | $631 | 591% |
| Aetna | $631 | 591% |
| Preferred Hlthcare - All Other Plans | $666 | 624% |
| Health Partners - All Plans | $666 | 624% |
| Healthy Blue Mcaid - All Plans | $701 | 656% |
Consumer Guidance & Cost Commentary
For the ultrasound of the pelvis at Rooks County Health Center in Plainville, Kansas, the cash price is $526.00, which is lower than the facility's negotiated rates of $631.00 and the gross charge of $701.00. This service is provided by a Critical Access Hospital, and while the facility is owned by a government hospital district, patients should be aware that commercial insurance plans often pay significantly more than the cash price due to administrative costs and contract structures. For instance, major payers like UnitedHealthcare, Aetna, and Preferred Benefits Admin have negotiated rates of $631.00, whereas the cash rate remains at $526.00. In cases where a patient has a high deductible or no insurance, paying the cash price directly can result in immediate savings compared to the amount an insurer would allow.
The Medicare benchmark for this procedure is $106.81, which serves as a baseline for evaluating the facility's pricing; the cash rate of $526.00 represents a markup relative to this federal standard. While the data does not provide specific county or state average comparisons for this exact code, patients should verify their specific plan's deductible status before scheduling, as some commercial rates may exceed the cash price if the patient has not yet met their out-of-pocket threshold. To potentially lower costs further, patients should contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront. Additionally, if a patient receives a bill after using insurance, they should request a detailed itemized statement