CMS Price Transparency Data

Ultrasound, abdomen (limited)

Facility: Saint Michael's Medical Center

Billing Code: 76705 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76705
Insurance Median: $131
Cash Discount Price: $121
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Ultrasound, abdomen (limited) at Saint Michael's Medical Center is $131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $121. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.23x the Medicare baseline. Located in 111 Central Avenue, Newark, NJ.

Cash / Self-Pay

$121

Average discount available for prompt cash payment at this facility.

Insurance Median

$131

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: $121 (113%)

Insurance Median: $131 (123%)

Cash: $121 (113% of Medicare)

Ins. Median: $131 (123% 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
Tricare	$97	91%
UnitedHealthcare	$109 - $163	102%
Aetna	$121 - $257	113%
Amerihealth	$121 - $134	113%
Horizon	$121 - $248	113%
Humana	$121	113%
Medicare (plans)	$121	113%
New Jersey Out of State	$121	113%
Wellpoint Amerigroup	$121	113%
Wellcare	$125 - $164	117%
Clover Health	$126	118%
Curana	$127	119%
Employer Direct Healthcare	$170	159%
Naphcare	$188	176%
Cigna	$194	182%
Fairprice Healthcare Holdings - Fphh	$194	182%
Coventry	$242	227%

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 $121.
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 Saint Michael's Medical Center 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.