Ultrasound, pelvis
Facility: Stanton County Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $624
- Cash Discount Price: $656
- vs. Medicare Baseline: 5.84x 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 584% of the Medicare baseline (a markup of 484%). 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 - $624 | 110% |
| Healthy Blue Mcr Adv - All Other Plans | $643 | 602% |
| Healthy Blue Mcaid | $656 | 614% |
Consumer Guidance & Cost Commentary
For the CPT code 76856 (Ultrasound, pelvis) at Stanton County Hospital in Johnson, KS, the cash price is $656.00, which matches the facility's gross charge and the median paid amount. This cash rate is significantly higher than the Medicare benchmark of $106.81, reflecting a markup common in commercial billing where negotiated rates often average 200% to 300% of the federal baseline. While the facility is a Critical Access Hospital with government local ownership, patients should note that commercial insurance negotiated rates for this service range from $624.00 to $656.00 across three payers, meaning the cash price is not necessarily the lowest option for those with active insurance coverage.
To minimize costs, patients with high-deductible plans may find it beneficial to pay the cash price of $656.00 directly, as this avoids the administrative overhead and potential higher negotiated rates associated with insurance claims. Before scheduling, it is advisable to contact the hospital to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront. Additionally, since the facility is in-network for the listed payers, patients should verify their specific deductible status to ensure they are not responsible for the full negotiated amount, and always request an itemized bill to review every charge for accuracy.