Ultrasound, abdomen (limited)
Facility: Decatur Health
Billing Code: 76705 (CPT)
- CPT Billing Code: 76705
- Insurance Median: $438
- Cash Discount Price: $517
- vs. Medicare Baseline: 4.10x 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 410% of the Medicare baseline (a markup of 310%). 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 | $151 | 141% |
| Wppa/Providrs Care- All Plans | $344 | 322% |
| UnitedHealthcare | $350 - $438 | 328% |
| Humana | $354 | 331% |
| Midlands Choice- All Plans | $517 | 484% |
| Aetna | $517 - $574 | 484% |
| Medicaid / KanCare | $580 | 543% |
Consumer Guidance & Cost Commentary
For this ultrasound procedure at Decatur Health in Oberlin, Kansas, the cash price is $517.00, which is lower than the facility's gross charge of $574.00. While the facility's negotiated rates with major payers like UnitedHealthcare and Aetna range from $350 to $580, the cash rate remains competitive. It is important to note that for patients with high-deductible plans, paying the cash price of $517.00 upfront can sometimes be more cost-effective than relying on insurance, as the insurer's negotiated rate may exceed the cash price. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the final amount owed.
When evaluating the cost of this service, it is crucial to compare rates against objective benchmarks rather than the facility's inflated list prices. The Medicare amount for this code is $106.81, which serves as the true cost baseline for healthcare delivery. Commercial negotiated rates often average 200% to 300% of the Medicare rate, whereas fair pricing is typically defined as 120% to 150% of this baseline. Patients should avoid accepting summary bills that obscure individual charges and instead request a detailed, itemized statement to identify any errors or unbundled codes. If a balance bill arises from an out-of-network provider, the No Surprises Act may protect patients from paying the difference between the provider's full charge and the insurance allowed amount, so disputes should be handled in writing rather than paid immediately out of fear.