CMS Price Transparency Data

Ultrasound, pelvis

Facility: Texas Health Arlington Memorial Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $584
Cash Discount Price: $861
vs. Medicare Baseline: 5.47x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Texas Health Arlington Memorial Hospital is $584. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $861. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.47x the Medicare baseline. Located in 800 W Randol Mill Rd, Arlington, TX.

Cash / Self-Pay

$861

Average discount available for prompt cash payment at this facility.

Insurance Median

$584

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: $861 (806%)

Insurance Median: $584 (547%)

Cash: $861 (806% of Medicare)

Ins. Median: $584 (547% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 547% of the Medicare baseline (a markup of 447%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Amerigroup	$96 - $110	90%
Blue Cross Blue Shield	$96 - $885	90%
Cook Childrens	$96	90%
Parkland	$96	90%
UnitedHealthcare	$96 - $578	90%
Superior Wellcare	$101 - $116	95%
Molina	$104 - $110	97%
American Health	$105	98%
Aetna	$106 - $1,006	99%
Healthspring	$107	100%
Humana	$109	102%
Fort Worth Firefighters	$378 - $877	354%
City Of Fort Worth	$675	632%
Cigna	$794 - $1,351	743%
Quick Trip	$861 - $905	806%
Phcs	$998 - $1,070	934%
Healthsmart	$1,077 - $1,206	1008%
Multiplan	$1,249	1169%
Galaxy	$1,263	1182%
Usa	$1,263	1182%

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 $861.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 76856.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Texas Health Arlington Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 76856.
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.