Ultrasound, pelvis
Facility: Community Memorial Healthcare, Inc.
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $268
- Cash Discount Price: $519
- vs. Medicare Baseline: 2.51x 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 251% of the Medicare baseline (a markup of 151%). 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 | $123 | 115% |
| Aetna | $239 - $389 | 224% |
| UnitedHealthcare | $297 | 278% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure (CPT 76856) at Community Memorial Healthcare, Inc. in Marysville, Kansas, the cash price is $519.00, which matches the facility's median negotiated rate. This cash price is significantly higher than the state average, as indicated by a 2.5x markup compared to Medicare reimbursement rates of $106.81. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance rates often exceed cash prices due to administrative overhead and contract dynamics. If you have a high-deductible plan, paying the full cash price of $519.00 upfront might result in lower out-of-pocket costs than your insurance applying its negotiated rate, which averages $239.00 but may be subject to deductibles or co-pays.
To minimize costs, we recommend contacting the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full before or shortly after the service. Although the facility lists a median negotiated payment of $268.00, this figure represents the average amount paid by insurers rather than a guaranteed discount for patients. It is crucial to verify your specific plan's allowed amount before scheduling, as assuming in-network status guarantees the lowest price can lead to unexpected charges if your deductible has not yet been met. Finally, if you receive an itemized bill, request a full line-by-line audit to ensure no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected through a