CMS Price Transparency Data

Ultrasound, pelvis

Facility: University of Miami Hospital and Clinics

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $1,114
Cash Discount Price: $542
vs. Medicare Baseline: 10.43x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at University of Miami Hospital and Clinics is $1,114. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $542. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.43x the Medicare baseline. Located in 1475 Nw 12Th Ave Suite 2175, Miami, FL.

Cash / Self-Pay

$542

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,114

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: $542 (507%)

Insurance Median: $1,114 (1043%)

Cash: $542 (507% of Medicare)

Ins. Median: $1,114 (1043% 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 1043% of the Medicare baseline (a markup of 943%). 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
UnitedHealthcare	$107 - $682	100%
Aetna	$115 - $1,103	108%
Solis Health	$117	110%
Humana	$121	113%
Sunshine Health	$278	260%
Molina Healthcare Of Fl	$334	313%
Oscar Health Of Fl	$351	329%
Amerihealth Caritas Fl	$354	331%
Careplus	$502	470%
Cigna	$515 - $620	482%
Blue Cross Blue Shield	$908 - $1,278	850%
Curative	$1,065	997%
Avmed	$1,145 - $1,306	1072%
Employers Health Network	$1,205	1128%
Simply Healthcare	$1,205	1128%
First Health	$1,306	1223%
Health First New York Health Insurance	$1,306	1223%
Broward Health	$1,406	1316%
Beech Street	$1,607	1505%
Dimension Health	$1,607	1505%
Multiplan	$1,607	1505%

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 $542.
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 University of Miami Hospital and Clinics 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.