CMS Price Transparency Data

Ultrasound, pelvis

Facility: Abrom Kaplan Memorial Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $329
Cash Discount Price: $319
vs. Medicare Baseline: 3.08x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Abrom Kaplan Memorial Hospital is $329. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $319. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.08x the Medicare baseline. Located in 1310 West Seventh Street, Kaplan, LA.

Cash / Self-Pay

$319

Average discount available for prompt cash payment at this facility.

Insurance Median

$329

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: $319 (299%)

Insurance Median: $329 (308%)

Cash: $319 (299% of Medicare)

Ins. Median: $329 (308% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 308% of the Medicare baseline (a markup of 208%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$180 - $319	169%
Verity Commercial And First Choice Network	$248	232%
Aetna	$319 - $551	299%
Healthy Blue Dual Advantage (Hmo-D-Snp)	$319	299%
Humana	$319 - $551	299%
Medicare (plans)	$319	299%
Ochsner Health Plan	$319	299%
UnitedHealthcare	$319 - $551	299%
Wellcare Of Louisiana	$319	299%
American Health Advantage Of Louisiana (Formerly Dignity Health Plan)	$329	308%
Tricare	$372	348%
Cigna	$496	464%
Zelis	$496	464%
Amerihealth Caritas Louisiana (Healthy Louisiana)	$551	516%
Healthy Blue (Healthy Louisiana)	$551	516%
Louisiana Healthcare Connections (Healthy Louisiana)	$551	516%

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 $319.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 76856.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Abrom Kaplan Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 76856.
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.