Ultrasound, pelvis
Facility: Morris County Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $364
- Cash Discount Price: $560
- vs. Medicare Baseline: 3.41x 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 341% of the Medicare baseline (a markup of 241%). 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 |
|---|---|---|
| Providrs Care (Wppa)(Nexus)-All Plans | $73 | 68% |
| Blue Cross Blue Shield | $126 - $364 | 118% |
| Va Ccn-All Plans | $364 | 341% |
| UnitedHealthcare | $364 - $934 | 341% |
| Coventry Mcr | $364 | 341% |
| Choice Care Mcr Adv-All Plans | $364 | 341% |
| Cigna | $676 | 633% |
| Aetna | $837 | 784% |
| Multiplan-All Plans | $841 | 787% |
| Coventry Comm-All Other Plans | $841 | 787% |
Consumer Guidance & Cost Commentary
For the pelvic ultrasound procedure (CPT 76856) at Morris County Hospital in Council Grove, KS, the cash median price is $560.00, which is significantly lower than the facility's negotiated rates. While the facility's median negotiated rate across its contracts is $364.00, individual payer contracts show a wide range, with some plans paying as high as $934.00 and others as low as $73.00. This variation highlights that being in-network does not guarantee the lowest price, as some commercial payers utilize higher administrative structures that inflate the baseline cost. For patients with high-deductible plans, paying the cash price of $560.00 upfront may be more cost-effective than relying on insurance, which could result in a negotiated rate exceeding the cash amount before the deductible is met.
The facility's pricing performance is evaluated against federal benchmarks, where the Medicare amount for this service is $106.81. The cash price of $560.00 represents a markup of 3.4 times the Medicare rate, while the median negotiated rate of $364.00 sits at approximately 3.4 times the Medicare amount as well. Given that fair pricing is typically defined as 120% to 150% of the Medicare rate, the current commercial rates reflect a significant markup common in the healthcare industry. To ensure you receive the most accurate and transparent billing, it is recommended to request an itemized bill before payment to verify that all charges are accurate and that no unbundled codes or services not rendered have been included. Additionally, patients should inquire directly with the hospital