Ultrasound, pelvis
Facility: William Newton Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $194
- Cash Discount Price: $540
- vs. Medicare Baseline: 1.82x 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.
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 | $126 - $194 | 118% |
| Triwest- All Plans | $189 | 177% |
| UnitedHealthcare | $194 - $486 | 182% |
| Ambetter / Centene | $194 - $540 | 182% |
| Providrs Care Nexus | $331 | 310% |
| Providrs Care - All Other Plans | $378 | 354% |
Consumer Guidance & Cost Commentary
For the pelvic ultrasound procedure (CPT 76856) at William Newton Hospital in Winfield, Kansas, the cash price is $540.00, which matches the facility's gross charge. This cash rate is significantly higher than the state average for this service, as indicated by the Medicare benchmarking ratio of 1.8, suggesting the facility's pricing is nearly double the federal baseline. While commercial insurance plans like Blue Cross Blue Shield and Triwest-All Plans have negotiated rates ranging from $126 to $194, these amounts often exceed the cash price for patients with high-deductible plans. In such cases, paying the full cash price of $540.00 upfront may be more cost-effective than relying on insurance, which could result in out-of-pocket costs exceeding the cash rate if deductibles are not yet met.
Patients should proactively request an itemized billing audit before finalizing payment to ensure no unbundled codes or services not rendered are included in the total, as over 80% of hospital bills contain errors. Additionally, it is advisable to inquire about prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid in full within a short window, bypassing the administrative costs associated with insurance claims processing. Since this facility is a Critical Access Hospital with government-local ownership, verifying the specific self-pay or prompt-pay classification at registration is essential to avoid automatic claims submission that would void any potential cash savings.