CMS Price Transparency Data

Ultrasound, pelvis

Facility: Ascension Seton Northwest

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $103
Cash Discount Price: $252
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Ascension Seton Northwest is $103. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $252. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.96x the Medicare baseline. Located in 11113 Research Boulevard, Austin, TX.

Cash / Self-Pay

$252

Average discount available for prompt cash payment at this facility.

Insurance Median

$103

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: $252 (236%)

Insurance Median: $103 (96%)

Cash: $252 (236% of Medicare)

Ins. Median: $103 (96% 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
Champva	$79 - $107	74%
Ambetter / Centene	$96 - $185	90%
Blue Cross Blue Shield	$96 - $454	90%
Dell Chip/Chip Perinate	$96	90%
Dell Star	$96	90%
UnitedHealthcare	$96 - $105	90%
Wellpoint Chip/Chip Perinate	$96	90%
Wellpoint Star	$96	90%
Wellpoint Star Kids	$96	90%
Wellpoint Star Plus	$96	90%
Aarp Mc Wellmed	$101	95%
Sendero Chap	$102	95%
Addr Cancer Together	$103	96%
Aetna	$103 - $830	96%
Covid Hrsa	$103	96%
Cshcn Cidc	$103	96%
Devoted Health Mcr Replacement	$103	96%
Humana	$103 - $136	96%
Medicare (plans)	$103	96%
Research Study	$103	96%
Smarthealth	$103	96%
Superior Allwell	$103	96%
Tricare	$103 - $148	96%
Wellcare Med Advantage	$103	96%
Connected Senior Care	$106	99%
Pphp Mcr Advantage	$108	101%
Tx Independence Hp	$108	101%
Occunet	$144	135%
Sendero Idealcare	$180	169%
Superior Star	$275 - $286	257%
Superior Star Foster	$275 - $286	257%
Superior Star Kids	$275 - $286	257%
Superior Star Plus	$275 - $286	257%
Superior Chip/Chip Perinate	$309 - $321	289%
Cigna	$350	328%
Seton Performance Plus	$356	333%
Covenant Health	$743	696%

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 $252.
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 Ascension Seton Northwest 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.