Ultrasound, pelvis
Facility: Phillips County Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $292
- Cash Discount Price: $275
- vs. Medicare Baseline: 2.73x 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 273% of the Medicare baseline (a markup of 173%). 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 | $133 - $262 | 125% |
| UnitedHealthcare | $258 - $323 | 242% |
| Medicaid / KanCare | $323 | 302% |
| Health Partners-All Plans | $323 | 302% |
Consumer Guidance & Cost Commentary
For this ultrasound procedure at Phillips County Hospital in Phillipsburg, KS, the facility's cash price of $275 is lower than the average negotiated rates paid by major insurers like UnitedHealthcare ($323) and Blue Cross Blue Shield ($262). While the hospital is a Critical Access Hospital owned by the local government, patients with high-deductible plans may find paying the cash price directly more affordable than relying on insurance, as the negotiated rates often exceed the cash amount. It is important to note that while Medicaid/KanCare and Health Partners-All Plans cover the full gross charge of $323, commercial payers negotiate lower maximums, meaning your out-of-pocket cost depends heavily on your specific plan's deductible status and whether the facility is truly in-network for your coverage.
To ensure you are not overcharged, always request a full itemized bill before paying, as summary invoices can hide unbundled charges or services not rendered. If you receive a balance bill for the difference between the provider's full charge and your insurance allowed amount, you may be protected under the No Surprises Act, which bans surprise billing for emergency care and non-emergency services at in-network facilities. Additionally, ask the billing department about prompt-pay discounts, which can reduce your final cost by 20% to 50% if you pay upfront, effectively bypassing the administrative overhead and collection fees that inflate insurance claims.