Ultrasound, pelvis
Facility: Girard Medical Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $273
- Cash Discount Price: $469
- vs. Medicare Baseline: 2.56x 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 256% of the Medicare baseline (a markup of 156%). 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 - $273 | 115% |
| Aetna | $273 - $1,367 | 256% |
| Ambetter / Centene | $273 | 256% |
| Kansas Superior Select-All Plans | $273 | 256% |
| Humana | $273 | 256% |
| UnitedHealthcare | $273 - $742 | 256% |
| Medicare (plans) | $273 | 256% |
| Multiplan-All Plans | $722 | 676% |
| Uhhis-All Plans | $742 | 695% |
Consumer Guidance & Cost Commentary
For the pelvic ultrasound procedure at Girard Medical Center, the facility's cash median rate of $469.00 is significantly higher than the negotiated rates paid by most major insurers, which average $273.00. While the facility is a Critical Access Hospital in Kansas, patients with high-deductible plans may find that paying the cash price directly is more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. It is important to note that while the facility offers a cash median of $469.00, the actual self-pay or prompt-pay discount could be lower if requested upfront before check-in.
The Medicare benchmark for this service is $106.81, which serves as the objective baseline for evaluating pricing markups. Commercial negotiated rates are typically 200% to 300% of Medicare, though fair pricing is generally defined as 120% to 150% of this amount. In this case, the negotiated rate of $273.00 represents a markup relative to the Medicare rate, and patients should be aware that balance billing is largely prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act. To ensure transparency and avoid unexpected costs, consumers should request an itemized bill to verify that all charges are accurate and that no unbundled codes or services not rendered have been included.