CMS Price Transparency Data

Ultrasound, abdomen (limited)

Facility: Fort Memorial Hospital

Billing Code: 76705 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76705
Insurance Median: $87
Cash Discount Price: $162
vs. Medicare Baseline: 0.81x Medicare

The contracted insurance negotiated median rate for a Ultrasound, abdomen (limited) at Fort Memorial Hospital is $87. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $162. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.81x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$162

Average discount available for prompt cash payment at this facility.

Insurance Median

$87

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: $162 (152%)

Insurance Median: $87 (81%)

Cash: $162 (152% of Medicare)

Ins. Median: $87 (81% 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
Mercycare	$25 - $608	23%
Blue Cross Blue Shield	$26 - $300	24%
Dean Health Plan	$26 - $851	24%
Humana	$26 - $131	24%
Molina	$26 - $102	24%
Quartz	$26 - $825	24%
UnitedHealthcare	$26 - $102	24%
Managed Health Services	$33 - $49	31%
Aetna	$42 - $612	39%
Medicaid / KanCare	$45	42%
Alliance	$71 - $586	66%
Fort Care	$87 - $270	81%
Centivo	$89 - $500	83%
Medicare (plans)	$102	95%
Group Health Cooperative	$112 - $528	105%
Veteran Evaluation Services	$127	119%
Trilogy	$162 - $718	152%
Cigna	$175 - $776	164%

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 $162.
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 Fort Memorial 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.