CMS Price Transparency Data

Ultrasound, pelvis

Facility: Freestone Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76856
  • Insurance Median: $460
  • Cash Discount Price: $1,074
  • vs. Medicare Baseline: 4.31x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at Freestone Medical Center is $460. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,074. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.31x the Medicare baseline. Located in 125 Newman St, Fairfield, TX.
Cash / Self-Pay
$1,074

Average discount available for prompt cash payment at this facility.

Insurance Median
$460

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: $1,074 (1006%)
Insurance Median: $460 (431%)
Cash: $1,074 (1006% of Medicare)
Ins. Median: $460 (431% 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 431% of the Medicare baseline (a markup of 331%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Gilsbar $97 - $1,534 91%
Blue Cross Blue Shield $118 - $1,380 110%
Aarp $120 112%
Apwu $120 112%
Fringe Benefits $120 112%
Geha $120 112%
Uhcss $120 112%
UnitedHealthcare $120 - $460 112%
Mcaid $137 - $322 128%
Misc Mcaid Hmo $137 - $460 128%
Superior Health Chip $137 - $322 128%
Tx Childrens Mcaid $137 - $322 128%
Amerigroup $163 - $460 153%
Medicaid / KanCare $163 - $709 153%
Rightcare S&W Mcaid $163 - $460 153%
Superior Health Mcd $163 - $709 153%
Cigna $920 861%
Misc Multiplan $1,074 1006%
Misc Multiplan Auto $1,074 1006%
Misc Multiplan Workcomp $1,074 1006%
Self Pay Gt 083123 $1,074 1006%
Self Pay Lt 090123 $1,074 1006%
Aetna $1,227 1149%
Aflac $1,534 1436%
Bankers Life $1,534 1436%
Fairview Nursing Home $1,534 1436%
Humana $1,534 1436%
Icare $1,534 1436%
Inmate Freestone Co $1,534 1436%
Misc Hospice $1,534 1436%
Miscellaneous $1,534 1436%
Miscellaneous Auto $1,534 1436%
Mutual Of Omaha $1,534 1436%
North American Med Empl $1,534 1436%
Standard Life Insurance $1,534 1436%
Tml $1,534 1436%
Zelis Healthcare $1,534 1436%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 125 Newman St, Fairfield, TX 75840
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Acute Care Hospitals