76816

Follow-up ultrasound scan of pregnant uterus

Medicare pricing data for 2,539 providers across 48 states

🤖AI Overview

Prices vary significantly by location — from $38 in West Virginia to $122 in District of Columbia. Where you get this procedure matters more than almost any other factor. This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Follow-up ultrasound scan of pregnant uterus (HCPCS code 76816) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $93.39, but hospitals typically charge $337.95 — a 3.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$18.68

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $93.39, your out-of-pocket cost would be approximately $18.68. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$93.39
Average Hospital Charge
$337.95
Markup Ratio
3.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$337.95
Medicare Allowed$93.39
Medicare Payment$69.29

Hospitals charge 3.6x more than what Medicare allows for this procedure. Medicare actually pays $69.29 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$122$3311371+30.9%
Maryland$110$34951111+18.0%
California$110$417112306+17.4%
Rhode Island$108$2541132+15.8%
Delaware$107$301929+14.7%
New York$105$406148412+12.5%
Florida$103$481163475+10.4%
Nevada$103$3862182+10.2%
Montana$103$223819+10.2%
Oregon$103$32648104+10.1%
Colorado$102$3563975+9.5%
New Jersey$102$36748111+9.3%
Georgia$102$42589282+9.0%
Virginia$99$25064137+5.8%
New Mexico$97$2871859+4.1%
Washington$97$30846121+4.0%
Texas$97$399177453+3.8%
Alabama$97$30348118+3.3%
South Carolina$95$31470133+1.5%
Oklahoma$94$2432581+1.1%
Wisconsin$94$63548120+1.0%
North Carolina$93$320157369-0.2%
Minnesota$93$33680135-0.8%
Tennessee$92$26368201-1.0%
Arizona$92$2824295-1.8%
Kentucky$91$25353121-2.8%
New Hampshire$90$3732039-4.0%
Arkansas$88$2303371-6.2%
Indiana$87$26381158-7.0%
Louisiana$86$3443471-8.2%
Nebraska$86$2913396-8.3%
Illinois$84$33863148-10.1%
Iowa$83$2824080-11.1%
Kansas$80$2922989-13.8%
Mississippi$80$2282564-13.9%
Michigan$80$225101199-14.5%
Missouri$80$2834690-14.7%
Connecticut$79$34939109-15.1%
Idaho$78$2861230-16.6%
Pennsylvania$77$20196255-17.5%
Massachusetts$77$27178212-17.5%
Utah$70$3071628-24.6%
South Dakota$68$2111338-27.0%
Ohio$62$22283155-33.2%
North Dakota$40$1421339-57.1%
Vermont$40$1321540-57.4%
Maine$40$2241671-57.6%
West Virginia$38$1491235-59.0%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber