CMS Price Transparency Data

Ultrasound, pelvis

Facility: North Shore Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76856
  • Insurance Median: $122
  • Cash Discount Price: $3,937
  • vs. Medicare Baseline: 1.14x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at North Shore Medical Center is $122. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,937. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.14x the Medicare baseline. Located in 1100 Nw 95Th St, Miami, FL.
Cash / Self-Pay
$3,937

Average discount available for prompt cash payment at this facility.

Insurance Median
$122

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: $3,937 (3686%)
Insurance Median: $122 (114%)
Cash: $3,937 (3686% of Medicare)
Ins. Median: $122 (114% 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Aetna $45 - $2,835 42%
Humana $59 - $206 55%
Veterans Administration Mill Bill $72 67%
Avmed Broad Network $92 86%
Medicare (plans) $93 - $3,937 87%
UnitedHealthcare $98 - $108 92%
Devoted Health $103 96%
Leon Health Inc $103 96%
Tricare $104 97%
Dimension Health Wc $105 98%
Employer Direct Healthcare $105 - $133 98%
Hospice Other $105 98%
Veterans Administration Vaccn $105 98%
Workers Compensation $105 98%
Medicaid / KanCare $106 - $3,937 99%
Cigna $108 - $1,969 101%
Healthsun Health Plans $108 - $110 101%
Longevity Health Plan $110 103%
Imagine Health $122 114%
Florida Pace Centers $124 116%
Bright Health Management Commercial $126 118%
Centurion Prison $129 121%
Self Pay/Uninsured $129 - $130 121%
Oscar Health Plan Hix $151 141%
Avmed Exchange $183 171%
Bc/Bs Of Fl Health Options Hmo $190 178%
Bc/Bs Of Fl Network Blue $190 178%
Bc/Bs Myblue Hmo Hix $192 180%
Ambetter / Centene $194 182%
Molina Marketplace Program Exchange $199 186%
Bc/Bs Of Fl Simplyblue $202 189%
Bc/Bs Of Fl Ppo $203 190%
Auto Insurance $209 196%
Bc/Bs Of Fl Blue Select Exchange Non Par $211 198%
Avmed Select Network $214 200%
Amerihealth Caritas Next Exchange $225 211%
Bc/Bs Of Fl Phs $2,041 1911%
Magellan Behavioral Health $2,362 2211%
Dimensions International $2,559 2396%
First Health $2,677 2506%
Dimension Health Ppo $2,953 2765%
Beacon Health Strategies Commercial $3,937 3686%
Commercial Non-Contracted $3,937 3686%
Self Pay - Mcd Pending 100 Percent $3,937 3686%
Single Case Agreement $3,937 3686%
United Behavioral Health Psych $3,937 3686%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1100 Nw 95Th St, Miami, FL 33150
  • CMS Rating: ★☆☆☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals