CMS Price Transparency Data

Ultrasound, pelvis

Facility: St Luke's Patients Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $272
Cash Discount Price: $1,041
vs. Medicare Baseline: 2.55x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at St Luke's Patients Medical Center is $272. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,041. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.55x the Medicare baseline. Located in 4600 East Sam Houston Parkway South, Pasadena, TX.

Cash / Self-Pay

$1,041

Average discount available for prompt cash payment at this facility.

Insurance Median

$272

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: $1,041 (975%)

Insurance Median: $272 (255%)

Cash: $1,041 (975% of Medicare)

Ins. Median: $272 (255% 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 255% of the Medicare baseline (a markup of 155%). 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
Chc	$91	85%
Tchp	$91	85%
Wellpoint	$96 - $160	90%
United	$98 - $592	92%
Blue Cross Blue Shield	$107 - $378	100%
Cigna	$107 - $2,083	100%
Humana	$107	100%
Kelsey	$107	100%
Aetna	$109 - $2,023	102%
Amerivantage	$110	103%
Devoted	$114	107%
Scanhealth	$114	107%
Ambetter / Centene	$160	150%
Community Health Choice	$160	150%
Bright Health	$182	170%
Coventry	$1,934	1811%
First Health	$1,934	1811%
Healthsmart	$2,083	1950%
Multiplan	$2,232	2090%

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 $1,041.
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 St Luke's Patients Medical Center 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.