Ultrasound, pelvis
Facility: Lincoln County Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $123
- Cash Discount Price: $420
- vs. Medicare Baseline: 1.15x 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 | $123 | 115% |
Consumer Guidance & Cost Commentary
For this ultrasound procedure at Lincoln County Hospital in Lincoln, KS, the cash price of $420.00 is notably lower than the facility's gross charge of $466.00. While the median negotiated rate for Blue Cross Blue Shield is $123.00, patients with high-deductible plans or those without insurance may find the cash price more advantageous, as the insurance negotiated rate can sometimes exceed the direct cash price. It is important to verify your specific plan's coverage and deductible status before scheduling, as paying out-of-pocket might result in a lower total cost than what your insurance would allow. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed if settled upfront.
This service is provided by a Critical Access Hospital, a facility type often subject to specific federal pricing regulations that can influence rates. The Medicare benchmark for this code is $106.81, which serves as a baseline for evaluating the facility's pricing structure; commercial rates are often significantly higher than this federal standard due to administrative costs and contract dynamics. Although the data does not include a direct comparison to state or county averages, understanding that Medicare represents the "true cost" of delivery helps contextualize the $466.00 gross charge. Consumers are advised to request an itemized bill to ensure no unbundled charges or services not rendered are included, and to dispute any balance bills immediately if they arise from out-of-network ancillary services, as federal protections like the No Surprises Act may apply.