Ultrasound, pelvis
Facility: Medicine Lodge Memorial Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $275
- Cash Discount Price: $290
- vs. Medicare Baseline: 2.57x 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 257% of the Medicare baseline (a markup of 157%). 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 |
|---|---|---|
| Tricare | $232 | 217% |
| Humana | $264 | 247% |
| Aetna | $268 - $290 | 251% |
| Hpk-All Plans | $275 | 257% |
| UnitedHealthcare | $275 | 257% |
| Medicaid / KanCare | $290 | 272% |
Consumer Guidance & Cost Commentary
For this ultrasound procedure at Medicine Lodge Memorial Hospital in Medicine Lodge, KS, the cash price is $290, which matches the facility's gross charge and the highest negotiated rate paid by Medicaid/KanCare. While the median negotiated rate across six payers is $275, patients with high-deductible plans may find paying the full cash price of $290 more cost-effective than relying on insurance, as commercial negotiated rates often exceed the cash price due to administrative overhead and contract structures. It is important to note that while the facility is a Critical Access Hospital owned by a Government Hospital District, the cash rate remains the same as the gross charge, meaning no self-pay or prompt-pay discounts are reflected in this specific data point.
When evaluating the cost relative to state benchmarks, the Medicare amount for this service is $106.81, which serves as the objective baseline for fair pricing. Commercial negotiated rates typically range from 200% to 300% of the Medicare rate, whereas fair pricing is generally defined as 120% to 150% of this amount. In this case, the cash price of $290 represents approximately 2.7 times the Medicare rate, consistent with the 2.6x comparison provided in the data. Patients should be aware that balance billing is largely prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but they should still request an itemized bill to ensure no unbundled codes or services not rendered are included in the final charge.