Imaging · 76946

Ultrasonic Guidance For Removal Of Amniotic Fluid

Medicare Payment (avg)
$19.35
What Medicare actually pays
Billed Charge (avg)
$161.25
What providers submit
Markup
8.3x
733% above Medicare rate
50
Total Services
50
Beneficiaries
48
Providers
0
States with Data

What You Might Pay

Est. Commercial Insurance
$55.99
Range: $39.19 – $78.39
Est. Cash / Self-Pay
$63.09
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: Imaging 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.

What the Data Says About Ultrasonic Guidance For Removal Of Amniotic Fluid

Across 0 states with reporting providers, CPT code 76946 (Ultrasonic Guidance For Removal Of Amniotic Fluid) shows a national average Medicare payment of $19.35 against an average billed charge of $161.25. That gap — a 8.3x markup, or 733% 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.

Imaging procedures like this one saw 50 services billed to Medicare in 2023 by 48 distinct providers, serving 50 unique beneficiaries. Regional variation is limited in the underlying CMS file. 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 Imaging category (2.24x), the estimated commercial insurance price lands near $55.99, with self-pay cash discounts commonly bringing the figure closer to $63.09. 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 Ultrasonic Guidance For Removal Of Amniotic Fluid cost?

The national average Medicare payment for Ultrasonic Guidance For Removal Of Amniotic Fluid (CPT 76946) is $19.35, while providers typically bill $161.25. Prices vary significantly by state, ranging from N/A to N/A.

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 Ultrasonic Guidance For Removal Of Amniotic Fluid cost with insurance?

With commercial insurance, Ultrasonic Guidance For Removal Of Amniotic Fluid costs an estimated $55.99 on average (range: $39.19 – $78.39). Without insurance, the estimated cash price is $63.09. These estimates are based on RAND 2024 research on commercial-to-Medicare price ratios. Your actual cost depends on your insurer, plan, and provider.

How many providers perform Ultrasonic Guidance For Removal Of Amniotic Fluid?

Nationally, 48 providers billed Medicare for Ultrasonic Guidance For Removal Of Amniotic Fluid in 2023, performing 50 total services for 50 beneficiaries across 0 states and territories.

What is the billed-to-Medicare markup for Ultrasonic Guidance For Removal Of Amniotic Fluid?

Providers bill 8.3x what Medicare pays for Ultrasonic Guidance For Removal Of Amniotic Fluid — a 733% 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