Ultrasound, pelvis
Facility: Smith County Memorial Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $279
- Cash Discount Price: $297
- vs. Medicare Baseline: 2.61x 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 261% of the Medicare baseline (a markup of 161%). 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 | $122 | 114% |
| Medicaid / KanCare | $208 - $297 | 195% |
| Multiplan-All Plans | $267 | 250% |
| Wppa-All Plans | $279 | 261% |
| Midlands Choice-All Plans | $282 | 264% |
| UnitedHealthcare | $282 | 264% |
| Health Partners Of Ks Ppo-All Plans | $282 | 264% |
Consumer Guidance & Cost Commentary
For this ultrasound procedure at Smith County Memorial Hospital in Smith Center, KS, the cash price is $297.00, which matches the facility's gross charge and the median amount paid by Medicaid/KanCare plans. While the facility is a Critical Access Hospital owned by the local government, the negotiated rates for in-network payers range from $208 to $297, with most commercial plans settling at $279.00. Because the cash price aligns with the highest negotiated rates, patients with high-deductible plans may find paying out-of-pocket directly cheaper than using insurance, which often incurs administrative fees and potential balance billing if the provider is out-of-network. We recommend asking the hospital specifically about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the cost for those who do not have insurance coverage.
It is important to distinguish between the facility's gross charge and the actual amount billed to patients. The Medicare benchmark for this service is $106.81, which serves as a scientifically validated baseline for the true cost of care, whereas commercial negotiated rates often exceed this by significant margins due to administrative overhead and contract dynamics. Although the data does not provide specific county or state average comparisons for this code, patients should be aware that balance billing can occur if they receive care from out-of-network providers, even at an in-network facility, potentially resulting in unexpected bills for the difference between the allowed amount and the full chargemaster rate. To avoid these surprises, consumers should request a detailed, itemized bill that breaks down every CPT code and service rendered, ensuring no unbundled charges or services not received are included before final