Ultrasound, pelvis
Facility: Graham County Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $215
- Cash Discount Price: $278
- vs. Medicare Baseline: 2.01x 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 201% of the Medicare baseline (a markup of 101%). 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% |
| Medicaid / KanCare | $145 | 136% |
| UnitedHealthcare | $145 - $264 | 136% |
| Medicare (plans) | $208 | 195% |
| Celtic Commercial-All Other Plans | $229 | 214% |
| Wppa (Providers Care)-All Plans | $264 | 247% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure of the pelvis at Graham County Hospital in Hill City, Kansas, the cash price is $278.00, which matches the facility's median negotiated rate. While the hospital is a Critical Access Hospital owned by the local government, patients should be aware that commercial insurance rates can sometimes exceed the cash price due to administrative overhead and contract structures. Specifically, UnitedHealthcare has a range of $145 to $264, and Medicaid/KanCare is set at $145, meaning the cash price of $278.00 is actually higher than the negotiated rates for these payers. However, if a patient has a high-deductible plan that has not yet met their out-of-pocket maximum, paying the cash price directly could result in lower total costs compared to the insurance negotiated rate, provided the patient can afford the upfront payment.
To ensure you are receiving the best possible rate, it is important to verify your specific plan's allowed amount before scheduling, as in-network rates vary significantly by carrier. For this service, Medicare allows $106.81, while the median negotiated rate across all payers is $215.00, and the median paid amount is $229.00. If you choose to pay out-of-pocket, ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% for upfront payments. Additionally, since over 80% of hospital bills contain errors, request a full itemized statement before paying to ensure no charges are double-billed or unbundled, and do not sign any waivers that might waive