Ultrasound, pelvis
Facility: Mitchell County Hospital Health Systems
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $536
- Cash Discount Price: $508
- vs. Medicare Baseline: 5.02x 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 502% of the Medicare baseline (a markup of 402%). 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 |
|---|---|---|
| UnitedHealthcare | $107 - $564 | 100% |
| Blue Cross Blue Shield | $123 | 115% |
| Triwest Well Mark All Plans | $479 | 448% |
| Pref Hlth Care Sytms Comm - All Plans | $508 | 476% |
| First Health-All Plans | $508 | 476% |
| Aetna | $508 | 476% |
| Phc Leased Ntwrk Access - All Plans | $536 | 502% |
| Auxiant-All Plans | $536 | 502% |
| Multiplan Ppo - All Plans | $536 | 502% |
| Health Partners Ks-All Plans | $558 | 522% |
| Cigna | $558 | 522% |
Consumer Guidance & Cost Commentary
For the pelvic ultrasound procedure (CPT 76856) at Mitchell County Hospital Health Systems in Beloit, KS, the cash price is $508, which is lower than the facility's negotiated rates with most insurers. While the facility is a Critical Access Hospital with government-local ownership, patients should be aware that commercial insurance plans often pay higher amounts than the cash price due to administrative costs and contract structures. For instance, UnitedHealthcare's negotiated rate ranges from $107 to $564, and other payers like Aetna and Cigna have fixed negotiated rates of $536 and $558, respectively. If you have a high-deductible plan, paying the $508 cash price upfront may result in significant savings compared to your insurance's allowed amount, provided you qualify for a prompt-pay discount.
It is important to distinguish between the facility's gross charge of $564 and the actual costs covered by insurance. Medicare, which serves as a benchmark for fair pricing, sets the rate at $106.81, highlighting that commercial negotiated rates can be substantially higher than the true cost of care. Since this facility is located in a Critical Access Hospital network, patients should verify their specific plan's deductible status before scheduling, as many in-network members may still face out-of-pocket costs if their deductible is not met. To ensure you receive the best possible rate, we recommend contacting the billing department directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these can reduce the final amount owed significantly compared to standard insurance processing.