CMS Price Transparency Data

Ultrasound, pelvis

Facility: Medical Center Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $221
Cash Discount Price: $588
vs. Medicare Baseline: 2.07x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Medical Center Hospital is $221. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $588. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.07x the Medicare baseline. Located in 500 W 4Th Street, Odessa, TX.

Cash / Self-Pay

$588

Average discount available for prompt cash payment at this facility.

Insurance Median

$221

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: $588 (551%)

Insurance Median: $221 (207%)

Cash: $588 (551% of Medicare)

Ins. Median: $221 (207% 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 207% of the Medicare baseline (a markup of 107%). 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
Corvel Wc	$84 - $91	79%
Medicaid / KanCare	$96 - $101	90%
Superior Chips	$96	90%
UnitedHealthcare	$96 - $918	90%
Ambetter / Centene	$99 - $109	93%
Amerigroup	$99	93%
Blue Cross Blue Shield	$99 - $395	93%
Community Health Choice	$99	93%
First Care Health Plan	$99	93%
Superior Health Plan	$99	93%
Aetna	$100 - $606	94%
Humana	$100	94%
Novitas Solutions	$103	96%
Triwest Va Ccn	$103	96%
Care Improvement Plus	$105	98%
Wellcare By Allwell	$109	102%
Group Resources	$126	118%
Workers Comp	$210	197%
Health Select	$217 - $395	203%
Cigna	$338 - $465	316%
Caprock	$367 - $441	344%
Healthsmart Preferred Care	$367 - $551	344%
90 Degree Benefits	$441	413%
State Comptroller	$459	430%
Texas Mutual Wc	$606	567%
Geha	$625	585%
Firstcare	$643	602%

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 $588.
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 Medical Center 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.