Ultrasound, pelvis
Facility: Goodland Regional Medical Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $637
- Cash Discount Price: $637
- vs. Medicare Baseline: 5.96x 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 596% of the Medicare baseline (a markup of 496%). 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% |
| Wppa | $602 - $637 | 564% |
| UnitedHealthcare | $637 | 596% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure code 76856 at Goodland Regional Medical Center in Goodland, Kansas, the cash median price is $637.00, which matches the median negotiated rate for both Wppa and UnitedHealthcare plans. This facility is a Critical Access Hospital with government-local ownership, and while the gross charge listed is $708.00, the actual amount paid by insurers averages $637.00. Patients with high-deductible plans may find this cash price advantageous, as it aligns with the negotiated rates that commercial insurers are contractually bound to pay, potentially avoiding balance billing if the patient pays directly. It is important to note that while the facility is in-network for these payers, patients should still verify their specific plan details to ensure they are not subject to unexpected out-of-network charges for ancillary services.
When evaluating costs against benchmarks, the Medicare amount for this service is $106.81, which serves as the federal baseline for pricing. The cash price of $637.00 represents a significant markup over the Medicare rate, reflecting the administrative costs and provider fees inherent in commercial billing structures. To minimize potential debt, patients should request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, since this is a self-pay scenario, patients should inquire about prompt-pay discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the administrative overhead associated with insurance claims processing.