Ultrasound, pelvis
Facility: Great Plains Of Sabetha
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $399
- Cash Discount Price: $420
- vs. Medicare Baseline: 3.74x 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 374% of the Medicare baseline (a markup of 274%). 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 |
|---|---|---|
| Celtic Mcr Adv | $218 | 204% |
| Aetna | $221 - $424 | 207% |
| Celtic Comm Exchange-All Other Plans | $273 | 256% |
| Great West Healthcare-All Plans | $357 | 334% |
| UnitedHealthcare | $391 - $420 | 366% |
| Cigna | $399 | 374% |
| Humana | $399 | 374% |
| Multiplan-Phcs-All Plans | $399 | 374% |
| Century/Wppa/Providers-All Plans | $399 | 374% |
| Federated Mutual Ins-All Plans | $403 | 377% |
| Medicaid / KanCare | $420 | 393% |
| Blue Cross Blue Shield | $420 | 393% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure of the pelvis at Great Plains Of Sabetha in Sabetha, Kansas, the cash price is $420.00, which matches the facility's gross charge and the Medicare benchmark of $106.81. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the cash rate is significantly higher than the Medicare amount, illustrating how commercial pricing often exceeds federal cost baselines. Patients with high-deductible plans may find paying the full cash price of $420.00 more affordable than using insurance, as the median negotiated rate paid by insurers is $357.00, yet many commercial plans will only cover a portion of this amount after deductibles are met, potentially leaving the patient responsible for a balance that exceeds the cash price.
The data shows a wide range of negotiated rates among 12 payers, with the lowest allowed amount being $218 and the highest at $420.00, indicating that the final out-of-pocket cost depends entirely on the specific insurance plan and its contract terms. Although the facility does not list a specific county or state average for comparison in this dataset, it is important for consumers to verify their specific plan's allowed amount before scheduling, as assuming that being in-network guarantees the lowest price can lead to unexpected costs. To minimize financial risk, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before check-in, as paying the bill in full upfront can sometimes reduce the total amount owed, and they should avoid signing any waivers that waive their rights to dispute out-of-network charges or request an itemized audit of the bill.