Ultrasound, pelvis
Facility: Clara Barton Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $488
- Cash Discount Price: $379
- vs. Medicare Baseline: 4.57x 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 457% of the Medicare baseline (a markup of 357%). 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% |
| 6 Degrees Health - All Plans | $379 | 355% |
| Wppa-All Plans | $434 | 406% |
| UnitedHealthcare | $488 | 457% |
| Phcs - All Plans | $488 | 457% |
| Aetna | $488 | 457% |
| Hlth Partners Of Ks-All Plans | $499 | 467% |
Consumer Guidance & Cost Commentary
For the ultrasound of the pelvis at Clara Barton Hospital in Hoisington, KS, the cash price is $379.00, which is lower than the facility's negotiated rate of $488.00 and the state average of $407.00. While many patients assume insurance will result in the lowest cost, this service's negotiated rate exceeds the cash price, meaning paying out-of-pocket could save you money if your insurance deductible has not yet been met. It is important to note that commercial insurance rates often include administrative overhead and contract markups that can make them higher than direct cash payments, so verifying your specific plan's allowed amount before scheduling is essential to avoid unexpected costs.
Patients should proactively request a prompt-pay discount or self-pay rate before check-in, as these upfront payment incentives can further reduce the final bill by bypassing costly insurance claims processing. Additionally, if you receive an itemized bill, ensure it is fully detailed rather than a summary to catch any errors or unbundled charges, as over 80% of hospital bills contain mistakes that can be corrected. While the facility is a Critical Access Hospital with a Medicare benchmark of $106.81, the commercial negotiated rates reflect standard market dynamics; however, understanding the difference between the gross charge, the negotiated rate, and the cash price empowers you to make informed financial decisions regarding your healthcare access.