CMS Price Transparency Data

Ultrasound, pelvis

Facility: Sweeny Community Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $786
Cash Discount Price: $730
vs. Medicare Baseline: 7.36x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Sweeny Community Hospital is $786. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $730. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.36x the Medicare baseline. Located in 305 North McKinney, Sweeny, TX.

Cash / Self-Pay

$730

Average discount available for prompt cash payment at this facility.

Insurance Median

$786

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: $730 (683%)

Insurance Median: $786 (736%)

Cash: $730 (683% of Medicare)

Ins. Median: $786 (736% 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 736% of the Medicare baseline (a markup of 636%). 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
Blue Cross Blue Shield	$365 - $608	342%
Evercare Mcaid	$608	569%
UnitedHealthcare	$657 - $973	615%
Aetna	$706 - $973	661%
Amerigroup Mcr Adv - All Other Plans	$706	661%
Community Hlth Choice Him - All Other Plans	$706	661%
Coventry Mcr Adv	$706	661%
Molina Mcr Adv - All Other Plans	$706	661%
Superior Hp Mcr Adv-All Other Plans	$706	661%
Wellcare Mcare - All Plans	$706	661%
Care Improvement Mcr - All Plans	$713	668%
Choicecare Mcr Adv - All Plans	$713	668%
Community Hlth Choice Star	$859	804%
Molina Mcaid	$859	804%
Superior Hp Mcaid	$859	804%
Tx Chlidrens Hp Mcaid - All Plans	$859	804%
Tx True Choice Mcaid - All Plans	$859	804%
Beech Street - All Plans	$912	854%
Community Care Network - All Plans	$973	911%
Galaxy Health Network - All Plans	$1,095	1025%
Multiplan - All Plans	$1,095	1025%
Evercare Mcr Adv - All Other Plans	$1,180	1105%
Amerigroup Mcaid	$1,216	1138%

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 $730.
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 Sweeny Community 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.