Ultrasound, pelvis
Facility: Clay County Medical Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $61
- Cash Discount Price: $358
- vs. Medicare Baseline: 0.57x 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 |
|---|---|---|
| Multiplan- All Plans | $32 - $619 | 30% |
| UnitedHealthcare | $41 - $619 | 38% |
| Aetna | $59 - $606 | 55% |
| Wppa/Providrs Care- All Plans | $59 - $606 | 55% |
| Health Partners - All Plans | $61 - $619 | 57% |
Consumer Guidance & Cost Commentary
For this ultrasound procedure at Clay County Medical Center in Clay Center, KS, the cash price is $358.00, which matches the facility's cash median. This rate is significantly lower than the state average for this service, where the median paid amount is $130.00. While commercial insurance plans like Multiplan, UnitedHealthcare, and Aetna negotiate rates ranging from $32 to $619, these figures often exceed the cash price. For patients with high-deductible plans, paying the $358.00 cash rate directly can be more cost-effective than relying on insurance, as the negotiated rates may not cover the full cost until the deductible is met. We recommend asking the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill.
To ensure you are not overcharged, it is important to request an itemized billing audit rather than accepting a summary bill that only shows broad categories. Since over 80% of hospital bills contain errors, such as unbundled codes or services not rendered, a detailed line-by-line review is the most effective way to identify and correct mistakes. Additionally, this facility's rates are benchmarked against Medicare, which sets a fixed reimbursement rate of $106.81 for this code. Commercial negotiated rates often average 200% to 300% of the Medicare amount, so comparing your specific allowed amount to the Medicare rate provides a clearer picture of fair pricing than looking at the hospital's inflated chargemaster list. If you receive a balance bill for out-of-network services, remember that the No Surprises Act protects you from