CMS Price Transparency Data

Ultrasound, pelvis

Facility: Holmes Regional Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $532
Cash Discount Price: $265
vs. Medicare Baseline: 4.98x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Holmes Regional Medical Center is $532. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $265. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.98x the Medicare baseline. Located in 1350 S Hickory St, Melbourne, FL.

Cash / Self-Pay

$265

Average discount available for prompt cash payment at this facility.

Insurance Median

$532

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: $265 (248%)

Insurance Median: $532 (498%)

Cash: $265 (248% of Medicare)

Ins. Median: $532 (498% 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 498% of the Medicare baseline (a markup of 398%). 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
Health First Health Plan	$57 - $316	53%
UnitedHealthcare	$79 - $1,060	74%
Molina Healthcare	$105 - $1,187	98%
Humana	$107 - $1,060	100%
Corizon Health	$109	102%
Aetna	$111 - $1,166	104%
Amerigroup	$111 - $1,113	104%
Sunshine Health Plan	$111 - $1,113	104%
Florida Healthcare Plans	$335	314%
Cigna	$408 - $437	382%
Disney Cruise Line	$636	595%
Florida Blue	$671 - $742	628%
Prime Heath Services, Inc.	$795	744%
Multiplan	$848	794%

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 $265.
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 Holmes Regional 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.