Ultrasound, pelvis
Facility: Regional Medical Center
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $870
- Cash Discount Price: $503
- vs. Medicare Baseline: 8.15x 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 815% of the Medicare baseline (a markup of 715%). 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 |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 815% |
Consumer Guidance & Cost Commentary
For an Ultrasound, pelvis procedure at Regional Medical Center in Manchester, Iowa, the most significant price benchmark is the Medicare rate of $106.81, which serves as the federal baseline for healthcare costs. While the facility's gross charge is listed at $629, the actual amount charged to patients varies significantly based on payment method; the cash median price is $503, and the negotiated rate paid by Medical Associates Health Plan - Tri is $870. This data highlights that for patients with high-deductible plans, paying cash at the median rate of $503 could result in substantial savings compared to the insurance negotiated rate of $870, provided the patient qualifies for self-pay or prompt-pay discounts.
The facility, a Critical Access Hospital owned by the local government, operates with a rating of 4 and is located at 709 W Main Street with a zip code of 52057. It is important to note that the negotiated rate of $870 represents the contractual ceiling for in-network coverage, whereas the cash price of $503 reflects the direct payment amount. Patients should be aware that hospitals often offer prompt-pay discounts, typically ranging from 20% to 50% off the billed amount, which can further reduce the $503 cash median. To ensure the lowest possible cost, consumers are advised to request a self-pay or prompt-pay classification before check-in and to avoid automatic claims submission, which would otherwise trigger the higher negotiated rate of $870.