Ultrasound, pelvis
Facility: Wamego Health Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $62
- Cash Discount Price: $564
- vs. Medicare Baseline: 0.58x 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 |
|---|---|---|
| UnitedHealthcare | $27 - $91 | 25% |
| Medicaid / KanCare | $28 - $94 | 26% |
| Aetna | $28 - $94 | 26% |
| Providrs Care | $44 - $140 | 41% |
| Tricare | $99 | 93% |
| Blue Cross Blue Shield | $162 - $170 | 152% |
Consumer Guidance & Cost Commentary
For the ultrasound of the pelvis at Wamego Health Center, the cash median price is $564.00, which is significantly lower than the facility's gross charge of $1,411.00. While insurance plans like UnitedHealthcare, Medicaid/KanCare, and Aetna have negotiated rates ranging from $27 to $94, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying cash directly. It is important to note that Medicaid/KanCare and Aetna show a wide range of $28 to $94 across their respective plans, so individual coverage could result in different out-of-pocket costs. To maximize savings, patients should explicitly ask the facility about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing costly insurance claims processing.
When evaluating the cost of this service, it is essential to compare rates against the Medicare benchmark rather than the hospital's full list price. The Medicare amount for this procedure is $106.81, and the facility's negotiated rates are substantially higher, reflecting the administrative overhead and contract dynamics of commercial insurance. Although the data does not provide specific state or county average comparisons for this specific code, the significant markup from the Medicare rate highlights how commercial negotiated rates can vary widely. Patients should avoid accepting summary bills and instead request a detailed, itemized statement to ensure no errors or unbundled charges are included, and they should verify their deductible status before relying on insurance to cover the full negotiated amount.