Ultrasound, pelvis
Facility: F W Huston Medical Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $524
- Cash Discount Price: $545
- vs. Medicare Baseline: 4.91x 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 491% of the Medicare baseline (a markup of 391%). 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% |
| Aetna | $511 | 478% |
| Humana | $538 | 504% |
| Cigna | $579 | 542% |
Consumer Guidance & Cost Commentary
For the pelvic ultrasound procedure (CPT 76856) at F W Huston Medical Center in Winchester, KS, the facility's cash price of $545.00 is notably higher than the state average of $538.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance negotiated rates for this service range from $511 to $579, which are generally higher than the cash price. This pricing dynamic suggests that for individuals with high-deductible plans, paying the cash rate of $545.00 upfront could result in significant savings compared to the insurance negotiated rates, as the administrative costs and contract markups embedded in commercial billing often inflate the final amount owed by the member.
To ensure you are receiving the most accurate and transparent pricing, it is critical to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, since the facility offers a cash median of $545.00, you should explicitly ask about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by 20% to 50% if paid in full within 30 days. While the facility's rates are compared against Medicare benchmarks to understand its cost basis, the most effective step for minimizing out-of-pocket expenses is to verify your specific plan's deductible status and confirm whether the hospital can classify the service as self-pay to bypass insurance processing fees.