CMS Price Transparency Data

Ultrasound, pelvis

Facility: Baylor Scott & White Medical Center Grapevine

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $448
Cash Discount Price: $705
vs. Medicare Baseline: 4.19x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Baylor Scott & White Medical Center Grapevine is $448. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $705. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.19x the Medicare baseline. Located in 1650 W College St, Grapevine, TX.

Cash / Self-Pay

$705

Average discount available for prompt cash payment at this facility.

Insurance Median

$448

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: $705 (660%)

Insurance Median: $448 (419%)

Cash: $705 (660% of Medicare)

Ins. Median: $448 (419% 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 419% of the Medicare baseline (a markup of 319%). 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
Baylor Scott & White Health Plan	$96 - $682	90%
Superior Health Plan	$96 - $106	90%
Aetna	$98 - $646	92%
Humana	$101 - $823	95%
Triwest	$101	95%
American Health Plan	$106	99%
Blue Cross Blue Shield	$106 - $448	99%
Corvel	$106	99%
Healthspring	$106	99%
Prime Health Services	$106	99%
Procare Advantage	$106	99%
UnitedHealthcare	$116 - $812	109%
Ambetter / Centene	$209	196%
Cigna	$579 - $682	542%
Employers Health Network	$646	605%
Quiktrip	$646	605%
Imagine Health	$673	630%
University Of Mary Hardin-Baylor	$682	639%
Curative	$764	715%
First Health	$823	771%
Healthsmart	$823 - $881	771%
Private Health Care System	$881	825%

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 $705.
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 Baylor Scott & White Medical Center Grapevine 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.