CMS Price Transparency Data

Ultrasound, pelvis

Facility: Baylor Scott & White Medical Center - Marble Falls

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $430
Cash Discount Price: $600
vs. Medicare Baseline: 4.03x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Baylor Scott & White Medical Center - Marble Falls is $430. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $600. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.03x the Medicare baseline. Located in 810 W Highway 71, Marble Falls, TX.

Cash / Self-Pay

$600

Average discount available for prompt cash payment at this facility.

Insurance Median

$430

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: $600 (562%)

Insurance Median: $430 (403%)

Cash: $600 (562% of Medicare)

Ins. Median: $430 (403% 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 403% of the Medicare baseline (a markup of 303%). 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
Baylor Scott & White Health Plan	$92 - $428	86%
Superior Health Plan	$96 - $97	90%
Humana	$97 - $700	91%
Triwest	$97	91%
American Health Plan	$102	95%
Blue Cross Blue Shield	$102 - $430	95%
Corvel	$102	95%
Healthspring	$102	95%
Prime Health Services	$102	95%
Procare Advantage	$102	95%
UnitedHealthcare	$111 - $553	104%
Sedgwick	$145	136%
Cigna	$514 - $603	481%
Aetna	$550	515%
Midcoast	$550	515%
Quiktrip	$550	515%
University Of Mary Hardin-Baylor	$580	543%
Independent Medical System	$600	562%
Curative	$650	609%
First Health	$700	655%
Healthsmart	$700 - $750	655%
Bluebell Creameries	$750	702%
Private Health Care System	$750	702%
Three Rivers	$900	843%

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 $600.
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 Baylor Scott & White Medical Center - Marble Falls 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.