CMS Price Transparency Data

Ultrasound, pelvis

Facility: Guadalupe Regional Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $156
Cash Discount Price: $223
vs. Medicare Baseline: 1.46x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Guadalupe Regional Medical Center is $156. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $223. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.46x the Medicare baseline. Located in 1215 E Court St, Seguin, TX.

Cash / Self-Pay

$223

Average discount available for prompt cash payment at this facility.

Insurance Median

$156

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: $223 (209%)

Insurance Median: $156 (146%)

Cash: $223 (209% of Medicare)

Ins. Median: $156 (146% 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
Superior Hlth Plan Mmcd	$83 - $332	78%
Aetna	$96 - $627	90%
Christus Exchange Health Plan	$96 - $105	90%
Mcr Clover Health	$96 - $105	90%
Mcr Texas Independence Health	$96 - $105	90%
Mcr Wellcare	$96 - $105	90%
Oscar Health Plan	$96 - $105	90%
Va Triwest Health Alliance	$96 - $105	90%
Healthcare Highways	$138 - $554	129%
UnitedHealthcare	$138 - $554	129%
Humana	$156 - $627	146%
Cigna	$166 - $664	155%
Texas Mutual Insurance Co	$166 - $664	155%
Blue Cross Blue Shield	$343 - $382	321%

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 $223.
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 Guadalupe Regional Medical Center 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.