Ultrasound, pelvis
Facility: Logan County Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $481
- Cash Discount Price: $140
- vs. Medicare Baseline: 4.50x 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 450% of the Medicare baseline (a markup of 350%). 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% |
| Humana | $297 | 278% |
| Health Partners - All Plans | $665 | 623% |
| Medicaid / KanCare | $700 | 655% |
Consumer Guidance & Cost Commentary
For the pelvic ultrasound procedure (CPT 76856) at Logan County Hospital in Oakley, KS, the facility's cash price of $140.00 is significantly lower than the negotiated rates charged to insurance payers, which range from $123 to $700 depending on the plan. This price point is notably lower than the state average for this service, offering a clear opportunity for cost savings. While commercial payers like Blue Cross Blue Shield and Humana negotiate rates of $123 and $297 respectively, the cash rate of $140 remains competitive. Patients with high-deductible plans or those without insurance may find that paying the cash price directly is more economical than relying on insurance, which often results in higher out-of-pocket costs due to deductibles and co-pays. It is advisable to confirm with the hospital whether a "self-pay" or "prompt-pay" discount is available, as these programs can further reduce the final amount owed.
The facility's negotiated rate of $481.00, which applies to most commercial insurance plans, is substantially higher than the cash price and exceeds the Medicare benchmark of $106.81 by a factor of 4.5 times. This markup reflects the administrative costs and contract structures inherent in commercial insurance billing, where rates often average 200% to 300% of Medicare levels. To ensure you are receiving the most accurate pricing, it is important to request an itemized bill rather than accepting a summary invoice, as detailed statements can reveal unbundled codes or services not rendered that may be causing inflated charges. Additionally, under the No Surprises Act, patients are