Ultrasound, pelvis
Facility: Amberwell Atchison Association
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $440
- Cash Discount Price: $977
- vs. Medicare Baseline: 4.12x 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 412% of the Medicare baseline (a markup of 312%). 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 | $117 - $123 | 110% |
| UnitedHealthcare | $296 - $1,753 | 277% |
| Va Ccn - All Plans | $322 | 301% |
| Humana | $322 - $440 | 301% |
| Superior Select Mcr Adv - All Plans | $322 | 301% |
| Triwest - All Plans | $322 | 301% |
| Ambetter / Centene | $500 | 468% |
| Cigna | $537 | 503% |
| Aetna | $537 | 503% |
| Oscar - All Plans | $733 | 686% |
| Centrus Health Direct - All Plans | $733 | 686% |
| Multiplan - All Plans | $762 | 713% |
| Wppa Providrs Care - All Plans | $879 | 823% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure code 76856 at Amberwell Atchison Association, the cash price is $977.00, which matches the facility's median paid amount. This rate is significantly higher than the Medicare benchmark of $106.81, reflecting a common markup where commercial rates often exceed 900% of the federal baseline. While the facility's negotiated rates with major payers like UnitedHealthcare range from $296 to $1,753, these amounts are generally higher than the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the $977.00 cash price directly, as this avoids the substantial administrative fees and potential out-of-pocket costs associated with insurance claims processing.
To ensure you receive the most accurate pricing, it is important to verify your specific plan's negotiated rate, which varies widely among the 13 payers listed, ranging from as low as $117 with Blue Cross Blue Shield to $879 with Wppa Providers Care. If you are self-paying, you should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final amount by 20% to 50% if settled upfront. Additionally, if you have insurance, be aware that balance billing could occur if you receive care from out-of-network providers, though the No Surprises Act protects you from such unexpected charges for emergency services at in-network facilities. Always request a full itemized bill before paying to ensure no errors or unbundled charges are included in the final invoice.