CMS Price Transparency Data

Ultrasound, pelvis

Facility: Frio Regional Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $501
Cash Discount Price: $399
vs. Medicare Baseline: 4.69x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Frio Regional Hospital is $501. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $399. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.69x the Medicare baseline. Located in 200 S Ih 35, Pearsall, TX.

Cash / Self-Pay

$399

Average discount available for prompt cash payment at this facility.

Insurance Median

$501

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: $399 (374%)

Insurance Median: $501 (469%)

Cash: $399 (374% of Medicare)

Ins. Median: $501 (469% 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 469% of the Medicare baseline (a markup of 369%). 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
Cigna	$121 - $127	113%
Amerigroup Texas	$128 - $134	120%
Superior Health Plan	$128 - $134	120%
Aetna	$416 - $437	389%
Blue Cross Blue Shield	$477 - $525	447%
UnitedHealthcare	$511 - $536	478%
Choicecare	$555 - $583	520%
Humana	$555 - $583	520%

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 $399.
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 Frio Regional 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.