Ultrasound, pelvis
Facility: Cloud County Health Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $326
- Cash Discount Price: $240
- vs. Medicare Baseline: 3.05x 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 305% of the Medicare baseline (a markup of 205%). 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 |
|---|---|---|
| Mpi-All Plans | $37 - $1,882 | 35% |
| Pponext-All Plans | $325 - $1,882 | 304% |
| Aetna | $1,783 - $1,842 | 1669% |
| Health Partners - All Plans | $1,882 | 1762% |
Consumer Guidance & Cost Commentary
For the pelvic ultrasound service at Cloud County Health Center in Concordia, KS, the facility's cash price of $240.00 is notably lower than the state average for this procedure. While commercial insurance plans like Mpi-All Plans and Pponext-All Plans have negotiated rates ranging from $37 to $1,882, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds $240.00. It is important to note that commercial negotiated rates often include administrative overhead and contract premiums, which can inflate the baseline price by 20% to 40% compared to direct cash payments.
The facility's median negotiated rate of $326.00 is higher than the Medicare benchmark of $106.81, reflecting a common markup structure where commercial rates average 200% to 300% of the federal baseline. To minimize costs, patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can bypass costly claims processing and reduce the final bill by 20% to 50%. Additionally, since over 80% of hospital bills contain errors, consumers are advised to demand a full itemized CPT-coded statement rather than accepting summary invoices, ensuring that all charges are accurate and that no services were billed for which care was not rendered.