CMS Price Transparency Data

Ultrasound, abdomen (limited)

Facility: T J Samson Community Hospital

Billing Code: 76705 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76705
Insurance Median: $106
Cash Discount Price: $301
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Ultrasound, abdomen (limited) at T J Samson Community Hospital is $106. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $301. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.99x the Medicare baseline. Located in 1301 North Race Street, Glasgow, KY.

Cash / Self-Pay

$301

Average discount available for prompt cash payment at this facility.

Insurance Median

$106

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $301 (282%)

Insurance Median: $106 (99%)

Cash: $301 (282% of Medicare)

Ins. Median: $106 (99% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$27 - $777	25%
Center Care Select - All Plans	$27 - $777	25%
Molina Mcr Adv	$27 - $108	25%
Signature Health - All Plans	$27 - $107	25%
Wellcare Mcr Adv - All Other Plans	$27 - $106	25%
Devoted Mcr Adv - All Plans	$28 - $112	26%
Humana	$28 - $106	26%
Caresource - All Plans	$34 - $159	32%
Molina Marketplace - All Other Plans	$34 - $159	32%
Aetna	$64 - $71	60%
Molina Mcaid	$66 - $73	62%
Wellcare Mcaid	$71 - $104	66%
UnitedHealthcare	$134 - $710	125%
Phcs/Multiplan - All Plans	$162 - $859	152%
First Health - All Plans	$163 - $868	153%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $301.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 76705.

Insurance In-Network Protection Plan

Contact your insurance company to confirm T J Samson Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 76705.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.