Ultrasound, abdomen (limited)
Facility: Nmc Health
Billing Code: 76705 (CPT)
- CPT Billing Code: 76705
- Insurance Median: $232
- Cash Discount Price: $270
- vs. Medicare Baseline: 2.17x 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 217% of the Medicare baseline (a markup of 117%). 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 |
|---|---|---|
| Bluestem Pace | $101 | 95% |
| Blue Cross Blue Shield | $131 | 123% |
| Aetna | $149 - $318 | 140% |
| Medicaid / KanCare | $162 | 152% |
| Leading Age | $162 | 152% |
| Wppa | $212 | 198% |
| Occunet | $232 | 217% |
| Samaritan Ministries International | $251 | 235% |
| Medincrease Health Plan | $251 | 235% |
| Prime Health Services | $290 | 272% |
| UnitedHealthcare | $347 | 325% |
| Cigna | $367 | 344% |
Consumer Guidance & Cost Commentary
For the CPT code 76705, Ultrasound, abdomen (limited), the facility's cash median rate is $270.00, which is lower than the negotiated rates paid by most insurance plans listed. While the gross charge is $386.00, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as many commercial payers negotiate rates significantly higher than the cash rate. For instance, Blue Cross Blue Shield and Medicaid/KanCare have negotiated rates of $131 and $162 respectively, which are higher than the cash price, whereas Aetna's range spans from $149 to $318 depending on the specific plan. To minimize costs, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final amount owed.
The facility's pricing is evaluated against a Medicare benchmark of $106.81, with the cash rate representing a 2.2x markup relative to this federal baseline. This comparison highlights that while the cash price is lower than most commercial negotiated rates, it still reflects a significant premium over the government-set cost basis. It is important to note that balance billing protections under the No Surprises Act generally prevent patients from being billed the difference between the chargemaster and the insurance allowed amount for emergency services or non-emergency care at in-network facilities. If a patient receives an unexpected bill, they should request an itemized audit to verify all charges and dispute any errors, as over 80% of hospital bills contain inaccuracies that can be corrected through formal written disputes.