Ultrasound, pelvis
Facility: Trego County Lemke Memorial Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $174
- Cash Discount Price: $217
- vs. Medicare Baseline: 1.63x 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 |
|---|---|---|
| Humana | $125 | 117% |
| Tricare | $135 | 126% |
| Medicaid / KanCare | $158 - $255 | 148% |
| Va Ccn - All Plans | $158 | 148% |
| Aetna | $158 - $230 | 148% |
| UnitedHealthcare | $158 - $255 | 148% |
| Blue Cross Blue Shield | $168 | 157% |
| Ambetter / Centene | $174 | 163% |
| Health Partners - All Plans | $242 | 227% |
| Healthy Blue Mcaid - All Plans | $255 | 239% |
Consumer Guidance & Cost Commentary
For the ultrasound of the pelvis at Trego County Lemke Memorial Hospital, the cash price is $217, which is lower than the facility's negotiated rates for most major payers, including UnitedHealthcare and Aetna. While the facility is a Critical Access Hospital in Wakeeney, KS, the data provided does not include specific county or state average figures for comparison. However, the cash rate of $217 is notably lower than the gross charge of $255 and falls within the range of what Medicaid/KanCare plans pay, with some plans negotiating as high as $255. Patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the insurance negotiated rates for many carriers exceed this amount.
To maximize savings, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling the procedure, as these upfront payment incentives can reduce the final bill by 20% to 50%. It is crucial to sign a waiver of insurance submission to ensure the hospital processes the account as a cash payment rather than submitting a claim that would trigger a higher negotiated rate. Additionally, if a balance bill arises from out-of-network ancillary services, patients should verify the legality of the charge under the No Surprises Act before paying, as federal protections often ban surprise billing for emergency care and non-emergency services at in-network facilities.