Ultrasound, abdomen (limited)
Facility: Holton Community Hospital
Billing Code: 76705 (CPT)
- CPT Billing Code: 76705
- Insurance Median: $633
- Cash Discount Price: $572
- vs. Medicare Baseline: 5.93x 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 593% of the Medicare baseline (a markup of 493%). 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 | $116 | 109% |
| UnitedHealthcare | $404 - $763 | 378% |
| Aetna | $404 - $763 | 378% |
| Humana | $408 | 382% |
| Kansas Superior Select - All Plans | $412 | 386% |
| Preferred Health Freedom | $633 | 593% |
| Preferred Health Fn Select - All Other Plans | $633 | 593% |
| Preferred Health Professionals | $633 | 593% |
| Wppa Providers - All Plans | $725 | 679% |
| Medicaid / KanCare | $763 | 714% |
Consumer Guidance & Cost Commentary
For the CPT code 76705, Ultrasound, abdomen (limited), Holton Community Hospital in Holton, KS, has a cash median price of $572.00 and a median negotiated rate of $633.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the negotiated rates paid by major payers like UnitedHealthcare and Aetna range from $404 to $763, which is higher than the cash price. This pricing dynamic suggests that for patients with high-deductible plans, paying the cash price of $572.00 upfront could result in significant savings compared to the insurance negotiated rates, provided the patient's plan does not cover the full amount. It is important to note that the cash price is also lower than the gross charge of $763.00, and patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling to ensure they receive the lowest possible rate.
The Medicare benchmark for this service is $106.81, which serves as a critical baseline for evaluating the facility's pricing markup. The facility's cash median of $572.00 represents a substantial markup relative to the Medicare rate, illustrating the difference between the federal government's cost-based reimbursement and commercial pricing. When comparing against the broader market, the facility's cash price is notably higher than the state and county averages for this procedure, which typically range between $400 and $600. However, the median negotiated rate of $633.00 aligns closely with the highest end of the payer range, indicating that while the