Ultrasound · 76817

Vaginal Ultrasound Of Pregnant Uterus

Medicare Payment (avg)
$40.25
What Medicare actually pays
Billed Charge (avg)
$238.28
What providers submit
Markup
5.9x
492% above Medicare rate
8.3K
Total Services
5.5K
Beneficiaries
5.8K
Providers
48
States with Data

Price Range Across States

Lowest State Avg
$20.84
Arkansas
Highest State Avg
$60.05
Montana

What You Might Pay

Est. Commercial Insurance
$126.80
Range: $88.76 – $177.53
Est. Cash / Self-Pay
$107.98
Typical self-pay discount

Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.

How we estimate these prices

These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Ultrasound procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.

Prices by State

State Medicare Payment Billed Charge
Montana $60.05 $201.54
New York $49.50 $297.96
Georgia $47.97 $256.81
New Mexico $47.26 $192.19
District of Columbia $46.96 $252.35
Nevada $46.70 $347.15
Arizona $46.50 $290.14
Maryland $46.34 $219.22
New Jersey $45.78 $252.28
Connecticut $45.76 $237.45
Nebraska $45.49 $255.32
California $44.67 $253.85
Rhode Island $44.67 $194.87
Colorado $43.36 $222.13
South Carolina $42.65 $275.16
Florida $42.53 $266.38
Kansas $42.05 $265.43
Mississippi $41.46 $199.66
Tennessee $41.36 $224.04
Minnesota $40.63 $218.83
Kentucky $40.37 $198.72
Louisiana $40.31 $231.26
Virginia $40.28 $173.96
Texas $40.00 $286.25
New Hampshire $39.95 $320.24
Oregon $39.77 $191.78
North Carolina $39.08 $236.06
Indiana $38.86 $200.03
Iowa $37.60 $237.89
Wisconsin $36.70 $479.27
Washington $36.49 $192.88
Oklahoma $36.14 $175.93
Delaware $36.09 $175.41
Massachusetts $35.35 $189.36
Illinois $34.89 $298.26
Michigan $34.75 $157.68
West Virginia $34.32 $179.75
Pennsylvania $33.70 $187.56
Ohio $32.79 $202.93
Missouri $32.71 $177.39
Alabama $30.97 $149.94
South Dakota $30.64 $134.20
North Dakota $28.27 $151.92
Vermont $24.79 $128.85
Idaho $24.39 $158.88
Utah $23.09 $105.83
Maine $20.99 $129.31
Arkansas $20.84 $129.68

What the Data Says About Vaginal Ultrasound Of Pregnant Uterus

Across 48 states with reporting providers, CPT code 76817 (Vaginal Ultrasound Of Pregnant Uterus) shows a national average Medicare payment of $40.25 against an average billed charge of $238.28. That gap — a 5.9x markup, or 492% above the Medicare allowed amount — reflects chargemaster pricing, not what most insured patients actually pay. Medicare's negotiated rate is the statutory benchmark; commercial insurers typically settle between the two figures based on network contracts.

Ultrasound procedures like this one saw 8.3K services billed to Medicare in 2023 by 5.8K distinct providers, serving 5.5K unique beneficiaries. State-level variation is significant: Arkansas reports the lowest average payment at $20.84, while Montana reports the highest at $60.05. Geographic Practice Cost Indices (GPCIs) explain much of that spread — local malpractice premiums, practice expense, and physician work adjustments all shift the allowed amount even when the procedure is identical.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Ultrasound category (2.24x), the estimated commercial insurance price lands near $126.80, with self-pay cash discounts commonly bringing the figure closer to $107.98. Uninsured patients facing the full billed charge have the strongest leverage to negotiate — the Hospital Price Transparency Rule (effective January 2021) requires providers to publish standard charges, cash rates, and payer-specific negotiated prices. This data is for educational reference; confirm coverage and out-of-pocket exposure with your insurer before any procedure.

Frequently Asked Questions

How much does Vaginal Ultrasound Of Pregnant Uterus cost?

The national average Medicare payment for Vaginal Ultrasound Of Pregnant Uterus (CPT 76817) is $40.25, while providers typically bill $238.28. Prices vary significantly by state, ranging from $20.84 to $60.05.

Why do providers charge more than Medicare pays?

Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.

How much does Vaginal Ultrasound Of Pregnant Uterus cost with insurance?

With commercial insurance, Vaginal Ultrasound Of Pregnant Uterus costs an estimated $126.80 on average (range: $88.76 – $177.53). Without insurance, the estimated cash price is $107.98. These estimates are based on RAND 2024 research on commercial-to-Medicare price ratios. Your actual cost depends on your insurer, plan, and provider.

Which state has the lowest cost for Vaginal Ultrasound Of Pregnant Uterus?

Arkansas has the lowest average Medicare payment for Vaginal Ultrasound Of Pregnant Uterus at $20.84, while Montana has the highest at $60.05. This $39.20 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.

How many providers perform Vaginal Ultrasound Of Pregnant Uterus?

Nationally, 5.8K providers billed Medicare for Vaginal Ultrasound Of Pregnant Uterus in 2023, performing 8.3K total services for 5.5K beneficiaries across 48 states and territories.

What is the billed-to-Medicare markup for Vaginal Ultrasound Of Pregnant Uterus?

Providers bill 5.9x what Medicare pays for Vaginal Ultrasound Of Pregnant Uterus — a 492% markup. This gap between billed charges and actual payment is common across healthcare. Uninsured patients may face charges closer to the billed amount, while insured patients pay negotiated rates between the Medicare and billed figures.

Related

Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure Editorial