CMS Price Transparency Data

Ultrasound, pelvis

Facility: Texas Childrens Hospital North Austin Campus

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $954
Cash Discount Price: $1,015
vs. Medicare Baseline: 8.93x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Texas Childrens Hospital North Austin Campus is $954. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,015. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.93x the Medicare baseline. Located in 9835 North Lake Creek Parkway Bldg A, Austin, TX.

Cash / Self-Pay

$1,015

Average discount available for prompt cash payment at this facility.

Insurance Median

$954

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: $1,015 (950%)

Insurance Median: $954 (893%)

Cash: $1,015 (950% of Medicare)

Ins. Median: $954 (893% 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 893% of the Medicare baseline (a markup of 793%). 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
Superior Chip	$96 - $101	90%
Driscoll Children'S Health Plan Mcd	$106	99%
UnitedHealthcare	$343 - $409	321%
First Care Health Plan	$409 - $970	383%
Molina Mcd	$454	425%
Blue Cross Blue Shield	$530 - $954	496%
Community Health Choice	$535 - $970	501%
Community First Health Plan Mcd	$606	567%
Cook Children'S Health Plan	$606	567%
Cigna	$626 - $970	586%
Aetna	$970	908%
Kelseycare	$985	922%
Healthsmart	$1,060	992%
Evolutions Healthcare	$1,136	1064%
First Health	$1,333 - $1,439	1248%
Multiplan	$1,364	1277%
Galaxy Health Network	$1,439	1347%

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 $1,015.
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 Texas Childrens Hospital North Austin Campus 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.