Ultrasound, pelvis
Facility: Sheridan County Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $187
- Cash Discount Price: $309
- vs. Medicare Baseline: 1.75x 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 | $183 | 171% |
| Celtic Insurance | $187 | 175% |
| UnitedHealthcare | $294 | 275% |
Consumer Guidance & Cost Commentary
For this pelvic ultrasound at Sheridan County Hospital in Hoxie, Kansas, the cash price is $309.00, which matches the facility's cash median. While the hospital is in-network for three major payers, their negotiated rates range from $183 to $294, meaning the cash price is actually the highest amount a patient would pay out-of-pocket for this service. It is important to note that for patients with high-deductible plans, paying the cash price of $309.00 upfront can sometimes be cheaper than having insurance cover the service, especially if the insurer's negotiated rate exceeds the cash price or if the patient has not yet met their deductible. Since the facility is a Critical Access Hospital with government-local ownership, patients should proactively ask about "self-pay" or "prompt-pay" discounts before scheduling to potentially lower the final cost.
The Medicare benchmark for this procedure is $106.81, which serves as a baseline for evaluating the facility's pricing markup. The gross charge of $309.00 is significantly higher than the Medicare amount, reflecting the standard administrative and service costs included in commercial billing. While the data does not provide a specific county or state average for comparison, the median negotiated rate across payers is $187.00, which is lower than the cash price. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though unexpected charges can still occur if ancillary services like labs are out-of-network. To ensure accuracy, consumers should request a full itemized bill rather than accepting a summary invoice, as this allows them to