CMS Price Transparency Data

Ultrasound, pelvis

Facility: Winter Haven Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $114
Cash Discount Price: $464
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Winter Haven Hospital is $114. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $464. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.07x the Medicare baseline. Located in 200 Ave F Ne, Winter Haven, FL.

Cash / Self-Pay

$464

Average discount available for prompt cash payment at this facility.

Insurance Median

$114

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: $464 (434%)

Insurance Median: $114 (107%)

Cash: $464 (434% of Medicare)

Ins. Median: $114 (107% 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.

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
Molina	$14 - $869	13%
Simply Healthcare	$14 - $265	13%
Ultimate Health Plan	$23 - $441	22%
Avmed	$24 - $720	22%
Blue Cross Blue Shield	$25 - $847	23%
Florida Hospital	$35 - $676	33%
Aetna	$36 - $1,198	34%
Evolutions	$38 - $1,367	36%
Cigna	$41 - $1,279	38%
UnitedHealthcare	$41 - $1,323	38%
Multiplan	$62 - $1,176	58%
First Health	$65 - $1,250	61%
Ambetter / Centene	$77 - $1,470	72%
United Behavioral Health	$77 - $1,470	72%
Clear Health Alliance	$106	99%
Baycareplus	$107	100%
Humana	$109 - $133	102%
Freedom Health	$111	104%
Molina Healthcare	$111	104%
Sunshine Health	$111	104%
Careplus	$113	106%
Florida Community Care	$116	109%
Solis Health	$117	110%
Freedom	$121	113%
Optimum	$121	113%
Health First	$123	115%
Wellcare	$149	140%

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 $464.
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 Winter Haven Hospital 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.