Ultrasound, pelvis
Facility: Hamilton County Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $290
- Cash Discount Price: $323
- vs. Medicare Baseline: 2.72x 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 272% of the Medicare baseline (a markup of 172%). 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 | $58 - $123 | 54% |
| First Health Coventry - All Plans | $274 | 257% |
| Cigna | $306 | 286% |
| UnitedHealthcare | $306 | 286% |
| Va Ccn - All Plans | $322 | 301% |
| Aetna | $548 | 513% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure on the pelvis at Hamilton County Hospital in Syracuse, KS, the cash price is $323.00, which matches the facility's median paid amount. This cash rate is significantly lower than the negotiated rates charged to insurance payers, with the lowest negotiated amount being $290.00 and the highest reaching $548.00. While the facility is in-network for several major carriers like Blue Cross Blue Shield and Cigna, patients with high-deductible plans may find the cash price more affordable if their insurance allows a higher allowed amount than the cash rate. It is important to note that the facility is a Critical Access Hospital with government-local ownership, and patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling to avoid being billed the full insurance negotiated rate.
The Medicare benchmark for this service is $106.81, which serves as a baseline for evaluating the facility's pricing markup. The cash price of $323.00 represents a 2.7x multiplier relative to the Medicare rate, indicating the standard commercial pricing structure. Although the data does not provide specific state or county average comparisons for this procedure, the facility's cash rate remains consistent across all three plans for Blue Cross Blue Shield, ranging from $58.00 to $123.00 depending on the specific plan. Patients are advised to review their specific plan details to determine if the cash price offers a genuine savings opportunity compared to their insurance allowed amount, and to ensure they do not inadvertently sign waivers that could lead to balance billing or void cash discounts.