Ultrasound, pelvis
Facility: Republic County Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $266
- Cash Discount Price: $217
- vs. Medicare Baseline: 2.49x 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 249% of the Medicare baseline (a markup of 149%). 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 |
|---|---|---|
| Rural Carriers-All Plans | $246 | 230% |
| Aetna | $260 | 243% |
| Meritain-All Plans | $260 | 243% |
| UnitedHealthcare | $266 | 249% |
| First Health-All Plans | $275 | 257% |
| Midlands Choice-All Plans | $275 | 257% |
| Cigna | $275 | 257% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure on the pelvis at Republic County Hospital, the negotiated rates paid by major insurers like Aetna, UnitedHealthcare, and Cigna range from $246 to $275, while the cash median price is $217. This cash rate is notably lower than the facility's gross charge of $289 and represents a potential savings for patients with high-deductible plans who may not have met their out-of-pocket limits. Although the facility is a Critical Access Hospital in Belleville, KS, with a facility rating of 3, patients should verify their specific plan's allowed amount before scheduling, as commercial negotiated rates often exceed cash prices due to administrative overhead and claim processing costs.
To maximize savings, patients should explicitly request a "self-pay" or "prompt-pay" discount prior to check-in, as hospitals often offer fee reductions of 20% to 50% for upfront payments that bypass costly insurance billing cycles. It is important to avoid accepting summary bills without reviewing the full itemized statement, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, patients should ensure they do not sign away their rights to dispute unexpected charges, and always compare the final cost against the Medicare benchmark of $106.81 to understand the true cost basis of the service.