Ultrasound, pelvis
Facility: Hiawatha Community Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $761
- Cash Discount Price: $977
- vs. Medicare Baseline: 7.12x 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 712% of the Medicare baseline (a markup of 612%). 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 | $117 - $123 | 110% |
| UnitedHealthcare | $361 - $839 | 338% |
| Aetna | $361 - $789 | 338% |
| Humana | $365 | 342% |
| Ambetter / Centene | $434 | 406% |
| Centrus Health Direct - All Plans | $733 | 686% |
| Oscar - All Plans | $733 | 686% |
| Preferred Hlth - All Plans | $879 | 823% |
| Cigna | $928 | 869% |
| Wppa Providrs Care - All Plans | $928 | 869% |
| Multiplan - All Plans | $948 | 888% |
| Midlands Choice - All Plans | $948 | 888% |
| Healthy Blue Mcaid - All Plans | $977 | 915% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure (CPT 76856) at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $977.00, which matches the facility's gross charge and the median cash rate. This cash price is significantly higher than the state average for this service, as indicated by a 7.1% variance compared to Medicare benchmarks. While many commercial payers negotiate rates ranging from $361 to $977, patients with high-deductible plans may find paying the full cash price upfront more cost-effective than relying on insurance, which often results in higher allowed amounts due to administrative overhead and claim processing costs. It is important to note that while the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the negotiated rates for in-network plans do not always reflect the lowest possible cost for the patient.
To potentially reduce the final bill, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling the appointment, as these upfront payment incentives can offer fee reductions of 20% to 50% by bypassing costly insurance billing cycles. Additionally, if you have insurance, be aware that balance billing could occur if you receive care from out-of-network providers, though the No Surprises Act protects you from surprise bills for emergency services and non-emergency services at in-network facilities. Finally, always request a detailed, itemized bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be corrected through a formal written audit dispute sent to the billing supervisor.