Ultrasound, pelvis
Facility: Decatur Health
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $294
- Cash Discount Price: $347
- vs. Medicare Baseline: 2.75x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 275% of the Medicare baseline (a markup of 175%). 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 | $159 | 149% |
| Wppa/Providrs Care- All Plans | $231 | 216% |
| UnitedHealthcare | $235 - $294 | 220% |
| Humana | $238 | 223% |
| Midlands Choice- All Plans | $347 | 325% |
| Aetna | $347 - $386 | 325% |
| Medicaid / KanCare | $390 | 365% |
Consumer Guidance & Cost Commentary
For this ultrasound procedure at Decatur Health in Oberlin, Kansas, the cash price of $347.00 is lower than the facility's negotiated rates with major insurers like UnitedHealthcare (ranging from $235 to $294) and Aetna (ranging from $347 to $386). While the facility's cash rate is higher than the state average for this service, it remains below the gross chargemaster price of $386.00. If you have a high-deductible plan where your deductible has not yet been met, paying the cash price directly could result in a lower out-of-pocket cost compared to your insurance's negotiated rate, which includes administrative overhead and claims processing fees.
To ensure you are receiving the best possible rate, it is important to verify your specific plan's allowed amount before scheduling, as commercial rates vary significantly by payer. Additionally, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront. If you receive a bill that includes charges for services not rendered or unbundled codes, you have the right to request a formal itemized audit to identify errors and avoid balance billing, especially if you are concerned about out-of-network ancillary services at an in-network facility.