Ultrasound, pelvis
Facility: Hospital District #6 Patterson Health Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $270
- Cash Discount Price: $240
- vs. Medicare Baseline: 2.53x 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 253% of the Medicare baseline (a markup of 153%). 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 | $116 - $122 | 109% |
| UnitedHealthcare | $270 - $300 | 253% |
| Providers Care (Wppa)-All Plans | $525 | 492% |
Consumer Guidance & Cost Commentary
For the CPT code 76856 (Ultrasound, pelvis) at Hospital District #6 Patterson Health Center in Anthony, KS, the facility's cash median price is $240.00, which is lower than the negotiated rates paid by UnitedHealthcare ($270.00). While the facility is a Critical Access Hospital with government ownership, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rate exceeds the cash amount. It is important to note that the facility does not list a specific self-pay or prompt-pay discount in this data, so patients should verify current payment options directly with the billing department before scheduling.
When evaluating the cost against federal benchmarks, the Medicare amount for this service is $106.81. The facility's cash price of $240.00 represents a markup of 2.5 times the Medicare rate, which aligns with the typical range where commercial rates average 200% to 300% of Medicare. Since no state or county average data is provided in this report, this comparison relies solely on the federal baseline. To ensure accuracy, patients should request an itemized bill to review specific CPT codes and avoid summary bills that may obscure individual charges, and they should confirm their deductible status before proceeding with any insurance claims.