Ultrasound, pelvis
Facility: Ellsworth County Medical Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $194
- Cash Discount Price: $215
- vs. Medicare Baseline: 1.82x 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.
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 |
|---|---|---|
| Healthy Blue Mcr Adv | $101 | 95% |
| Humana | $101 - $204 | 95% |
| Va Ccn-All Plans | $101 | 95% |
| Triwest -All Plans | $101 | 95% |
| Blue Cross Blue Shield | $116 - $122 | 109% |
| UnitedHealthcare | $140 - $215 | 131% |
| Aetna | $194 | 182% |
| First Health - All Plans | $194 | 182% |
| Cigna | $204 | 191% |
| Healthy Blue Mcaid- All Other Plans | $215 | 201% |
| Medicaid / KanCare | $215 | 201% |
| Coventry Mcaid-All Plans | $215 | 201% |
| Providers Care-Wppa-All Plans | $322 | 301% |
Consumer Guidance & Cost Commentary
For the pelvic ultrasound procedure (CPT 76856) at Ellsworth County Medical Center in Ellsworth, Kansas, the cash price is $215.00, which matches the facility's maximum negotiated rate with some payers. This cash price is significantly higher than the state average for this service, which is $167.00. While the facility is a Critical Access Hospital with a proprietary ownership structure, patients should be aware that paying cash directly can sometimes be more cost-effective than using insurance if their plan's negotiated rate exceeds the cash price. In this specific case, the cash rate is identical to the highest negotiated amounts, meaning there is no financial advantage to using insurance for this service unless the patient's specific plan negotiates a lower rate than the facility's maximum.
To ensure you are receiving the best possible price, it is highly recommended to ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling your appointment. These discounts can reduce the final bill by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims processing. Additionally, if you receive a bill, always request an itemized statement that lists every specific CPT code and unit cost rather than accepting a summary bill, as over 80% of hospital bills contain errors such as double-billing or unbundled charges. Comparing this facility's rates to the Medicare benchmark of $106.81 reveals a markup of 1.8 times the federal rate, which is consistent with commercial pricing structures where negotiated rates often average 200% to 300% of Medicare amounts.