CMS Price Transparency Data

Ultrasound, pelvis

Facility: HCA Florida Twin Cities Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $2,411
Cash Discount Price: $6,345
vs. Medicare Baseline: 22.57x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at HCA Florida Twin Cities Hospital is $2,411. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,345. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 22.57x the Medicare baseline. Located in 2190 Hwy 85 N, Niceville, FL.

Cash / Self-Pay

$6,345

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,411

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: $6,345 (5940%)

Insurance Median: $2,411 (2257%)

Cash: $6,345 (5940% of Medicare)

Ins. Median: $2,411 (2257% 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 2257% of the Medicare baseline (a markup of 2157%). 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
United	$245 - $2,855	229%
Simply	$977	915%
Corvel Corporation	$1,046	979%
Prime Health	$1,068	1000%
Careworks (Rockport Community)	$1,101	1031%
Molina Healthcare	$1,206 - $2,030	1129%
Avmed	$1,523 - $3,172	1426%
Sunshine State Health Plan	$1,618	1515%
Aetna	$1,904	1783%
Humana	$2,411	2257%
Plotkin Health	$3,172	2970%
Prime Health Sheriff	$3,172	2970%
Evolutions Healthcare	$4,124 - $5,393	3861%
Multiplan	$4,949 - $5,393	4633%
Ppo Next	$5,393	5049%
Novanet	$5,710	5346%

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 $6,345.
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 HCA Florida Twin Cities 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.