Ultrasound, pelvis
Facility: Fredonia Regional Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $215
- Cash Discount Price: $239
- vs. Medicare Baseline: 2.01x 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 201% of the Medicare baseline (a markup of 101%). 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 | $118 - $123 | 110% |
| Veterans Programs - All Plans | $122 | 114% |
| Aetna | $122 - $215 | 114% |
| UnitedHealthcare | $122 - $215 | 114% |
| Reserve National-All Plans | $215 | 201% |
| Meritain-All Plans | $215 | 201% |
| Cigna | $215 | 201% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure of the pelvis at Fredonia Regional Hospital in Kansas, the cash price is $239.00, which matches the facility's median negotiated rate of $215.00 and the cash median. This cash price is significantly higher than the Medicare benchmark of $106.81, reflecting a markup common in commercial billing where rates often average 200% to 300% of the federal baseline. While the facility is a Critical Access Hospital with government local ownership, the data does not provide specific county or state average comparisons for this code, so patients should verify local pricing trends directly with the hospital or their insurer. Because the cash price equals the negotiated rate, patients with high-deductible plans who have not yet met their out-of-pocket maximum may find paying the full $239.00 upfront more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if the deductible is not satisfied.
Patients should proactively ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% for upfront payment. Since the facility's billing systems may automatically submit claims to insurance even for self-pay patients, it is crucial to request a waiver of insurance submission before check-in to ensure the cash discount applies. Additionally, if you have received a bill, you should request a full itemized statement rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. Given that the No Surprises Act protects patients from balance billing for emergency care and non-emergency services at in-network facilities