Ultrasound, pelvis
Facility: Wilson Medical Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $195
- Cash Discount Price: $183
- vs. Medicare Baseline: 1.83x 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.
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 - $244 | 114% |
| Aetna | $129 - $244 | 121% |
| Ambetter / Centene | $129 - $244 | 121% |
| Humana | $129 | 121% |
| UnitedHealthcare | $129 - $227 | 121% |
| Tricare | $129 | 121% |
| Cigna | $195 | 183% |
| Health Partners-All Plans | $224 | 210% |
| Mulitplan-All Plans | $224 | 210% |
Consumer Guidance & Cost Commentary
This ultrasound service at Wilson Medical Center in Neodesha, Kansas, carries a Medicare benchmark of $106.81, which serves as the objective baseline for evaluating pricing fairness. While the facility's cash median price is $183.00 and the median negotiated rate across payers is $195.00, these figures are significantly higher than the Medicare amount, reflecting the typical commercial markup structure. For patients with high-deductible plans, paying the cash median of $183.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price due to administrative overhead and contract dynamics. It is important to note that the facility is a Critical Access Hospital with government-local ownership, which may influence its pricing strategy compared to larger urban centers.
Before scheduling, patients should verify their specific insurance plan's negotiated rate, as commercial rates vary by carrier and can differ substantially from the facility's general averages. For instance, while Blue Cross Blue Shield and Aetna have negotiated ranges starting at $122 and $129 respectively, other payers like Cigna and Health Partners have fixed negotiated amounts of $195.00 and $224.00. To minimize out-of-pocket costs, patients are encouraged to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full prior to service. Additionally, if you have insurance, ensure you have met your deductible before assuming the negotiated rate will apply, as you may still be responsible for the full amount until that threshold is reached.