Ultrasound, pelvis
Facility: Nemaha Valley Community Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $426
- Cash Discount Price: $763
- vs. Medicare Baseline: 3.99x 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 399% of the Medicare baseline (a markup of 299%). 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% |
| Va Ccn - All Plans | $373 | 349% |
| Humana | $373 | 349% |
| Aetna | $377 - $721 | 353% |
| Celtic Comm Exch - All Plans | $410 | 384% |
| Partners Direct Health - All Plans | $441 | 413% |
| Multiplan - All Plans | $763 | 714% |
| Midlands Choice - All Plans | $806 | 755% |
| Health Partners - All Plans | $806 | 755% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure on the pelvis at Nemaha Valley Community Hospital in Seneca, KS, the cash price is $763.00, which is significantly lower than the facility's negotiated rates with major payers like Aetna ($763–$806) and Multiplan ($763). While the facility's cash rate matches the lowest negotiated amount found for this service, it is important to note that commercial insurance plans often pay negotiated rates that exceed the cash price, making self-pay a potentially more affordable option for patients with high-deductible plans who have not yet met their coverage thresholds. The facility, a voluntary non-profit Critical Access Hospital, lists a cash median of $763.00, which aligns with the lowest end of the negotiated spectrum, but patients should verify their specific plan's deductible status before scheduling to avoid unexpected out-of-pocket costs.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, it is crucial to request an itemized bill to ensure all charges are accurate and that no unbundled codes or services not rendered have been included. Since over 80% of hospital bills contain errors, consumers are advised to dispute any discrepancies in writing rather than accepting summary invoices as final. Additionally, if you choose to pay out-of-pocket, ask the billing department about prompt-pay discounts, which can reduce the total cost by 20% to 50% for upfront payment, effectively bypassing the administrative overhead and claim processing fees that inflate insurance negotiated rates.