Ultrasound, pelvis
Facility: Kearny County Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $495
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 4.63x 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 463% of the Medicare baseline (a markup of 363%). 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 |
|---|---|---|
| Community Care Health Plan Of | $495 | 463% |
| UnitedHealthcare | $495 | 463% |
| Blue Cross Blue Shield | $495 | 463% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure on the pelvis at Kearny County Hospital in Lakin, KS, the facility's negotiated rate is $495, which matches the lowest and highest amounts reported by all three major payers, including Community Care Health Plan, UnitedHealthcare, and Blue Cross Blue Shield. This rate is significantly higher than the Medicare benchmark of $106.81, reflecting the typical administrative markup associated with commercial insurance contracts. While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans or those who have not yet met their out-of-pocket maximums may find the cash price more advantageous. Although the data does not list a specific cash rate, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, as paying upfront can often bypass the administrative costs and insurance processing fees that inflate the negotiated amount.
It is important to understand that the $495 figure represents the maximum allowed amount under contract, not necessarily the final charge you will receive. If your insurance plan has a high deductible, you may be responsible for paying this full negotiated amount before your plan begins to cover costs, which could exceed the cost of paying cash directly. Furthermore, if you are an out-of-network patient receiving care at this in-network facility, you are protected by the No Surprises Act, which prevents balance billing for emergency services and non-emergency services from out-of-network providers at in-network facilities. If you receive a bill that appears to include charges beyond the negotiated rate, you should request a formal itemized audit to identify any unbundled codes or services not rendered, ensuring you are not paying for unnecessary or duplicated items.