Ultrasound, pelvis
Facility: Memorial Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $990
- Cash Discount Price: $343
- vs. Medicare Baseline: 9.27x 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 927% of the Medicare baseline (a markup of 827%). 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 |
|---|---|---|
| Tricare | $31 - $990 | 29% |
| Ambetter / Centene | $34 - $1,089 | 32% |
| Blue Cross Blue Shield | $41 - $130 | 38% |
| Humana | $990 | 927% |
| Medicare (plans) | $1,000 | 936% |
| Coventry - All Other Plans | $1,783 | 1669% |
| Health Partners Of Kansas - All Plans | $1,882 | 1762% |
| Preferred Healthcare-All Plans | $1,882 | 1762% |
| Wppa/Providers Care-All Plans | $2,773 | 2596% |
Consumer Guidance & Cost Commentary
For this ultrasound procedure in Abilene, KS, the cash price is $343, which is significantly lower than the facility's negotiated rates with major payers like Tricare ($31–$990) and Blue Cross Blue Shield ($41–$130). While the facility's cash rate is lower than the median negotiated amount of $990, it is important to note that commercial insurance rates often include administrative overhead and can exceed the cash price. Patients with high-deductible plans may find paying the $343 cash rate more cost-effective than relying on insurance, especially if their deductible has not yet been met or if the insurer's allowed amount is high. Additionally, Memorial Hospital, a Critical Access Hospital owned by a government authority, offers a prompt-pay discount for upfront payments, which can further reduce the final bill.
When evaluating costs, it is crucial to compare rates against the Medicare benchmark rather than the facility's gross chargemaster. The Medicare reimbursement for this service is $106.81, and the facility's cash rate of $343 represents a markup relative to this federal baseline. While the data does not provide specific state or county average comparisons for this specific CPT code, the facility's cash rate is notably lower than the highest negotiated rates found for this service, such as the $2,773 charged by Wppa/Providers Care. Consumers should request an itemized bill to ensure no errors exist, as over 80% of hospital bills contain discrepancies. If a balance bill arises from an out-of-network ancillary service, patients should dispute it under the No Surprises Act, as federal protections prevent providers from billing for the difference