Ultrasound, pelvis
Facility: Hodgeman County Health Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $392
- Cash Discount Price: $446
- vs. Medicare Baseline: 3.67x 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 367% of the Medicare baseline (a markup of 267%). 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 | $117 - $123 | 110% |
| UnitedHealthcare | $356 - $529 | 333% |
| Humana | $356 | 333% |
| Medicaid / KanCare | $356 - $557 | 333% |
| Triwest - All Plans | $356 | 333% |
| Aetna | $446 | 418% |
| First Health - All Plans | $501 | 469% |
| Health Partners - All Plans | $529 | 495% |
| Wppa (Provdrscare) - All Plans | $529 | 495% |
Consumer Guidance & Cost Commentary
For the Ultrasound, pelvis procedure at Hodgeman County Health Center in Jetmore, KS, the cash price of $446.00 is notably higher than the facility's negotiated rate of $392.00 and the median paid amount of $419.00. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that commercial insurance rates often exceed cash prices due to administrative overhead and contract structures. In this specific case, the cash price is actually lower than the negotiated rates for most payers, including UnitedHealthcare and Medicaid/KanCare, which range from $356 to $529. This suggests that for patients with high-deductible plans or those who have already met their out-of-pocket maximums, paying the cash price directly could result in lower total costs compared to using insurance, provided the facility accepts the cash payment as a valid settlement.
To maximize savings, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling the appointment, as these upfront incentives can further reduce the $446.00 cash price. It is also important to note that Medicare reimbursement for this service is set at $106.81, which serves as a baseline for evaluating the facility's pricing; however, commercial rates are typically higher than this benchmark due to varying service levels and geographic adjustments. Since the facility is in-network for nine major payers, balance billing is unlikely for the primary service, but patients should still review their itemized bill to ensure no unexpected charges for ancillary services. If you have already received a bill, request a full itemized statement to verify that all codes