Ultrasound, pelvis
Facility: Holton Community Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $674
- Cash Discount Price: $609
- vs. Medicare Baseline: 6.31x 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 631% of the Medicare baseline (a markup of 531%). 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 | $122 | 114% |
| UnitedHealthcare | $430 - $812 | 403% |
| Aetna | $430 - $812 | 403% |
| Humana | $435 | 407% |
| Kansas Superior Select - All Plans | $439 | 411% |
| Preferred Health Freedom | $674 | 631% |
| Preferred Health Fn Select - All Other Plans | $674 | 631% |
| Preferred Health Professionals | $674 | 631% |
| Wppa Providers - All Plans | $771 | 722% |
| Medicaid / KanCare | $812 | 760% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure (CPT 76856) at Holton Community Hospital in Holton, KS, the cash price of $609.00 is significantly lower than the negotiated rates commercial insurers typically pay, which range from $430 to $812. While Medicaid and KanCare pay a fixed $812, most private payers like UnitedHealthcare and Aetna have negotiated rates between $430 and $812, reflecting the administrative costs and contract structures that often inflate commercial pricing. This facility, a Critical Access Hospital, operates with a cash median of $609.00, which is notably higher than the state of Kansas average for this service but aligns closely with the negotiated rates seen across multiple payer plans. Patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the $609.00 rate avoids the multi-layered administrative structures that can add 20% to 40% to the baseline cost when insurance claims are processed.
To minimize out-of-pocket expenses, patients should proactively request self-pay or prompt-pay discounts before scheduling, as these upfront payment incentives can bypass the costly claims processing cycle and reduce the final bill by 20% to 50%. It is important to verify your deductible status before relying on insurance, as paying the full negotiated rate without meeting your deductible can result in higher costs than paying cash outright. Additionally, while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, patients should always demand a detailed, itemized bill to ensure no errors or unbundled charges are included, as over 8