CMS Price Transparency Data

Ultrasound, pelvis

Facility: HCA Florida Jfk Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $1,179
Cash Discount Price: $5,360
vs. Medicare Baseline: 11.04x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at HCA Florida Jfk Hospital is $1,179. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,360. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.04x the Medicare baseline. Located in 5301 S Congress Ave, Atlantis, FL.

Cash / Self-Pay

$5,360

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,179

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: $5,360 (5018%)

Insurance Median: $1,179 (1104%)

Cash: $5,360 (5018% of Medicare)

Ins. Median: $1,179 (1104% 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 1104% of the Medicare baseline (a markup of 1004%). 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 - $2,412	229%
Freedom Health	$461 - $858	432%
Optimum	$461	432%
Healthy Palm Beaches	$550	515%
Avmed	$697 - $2,680	653%
Simply Healthcare Plans	$697	653%
Molina	$911 - $1,447	853%
Corvel Corporation	$1,087	1018%
Careworks (Rockport)	$1,110	1039%
Prime Health	$1,110	1039%
Humana	$1,126 - $1,822	1054%
Health Sun Health Plan	$1,142	1069%
Aids Healthcare	$1,179 - $6,432	1104%
Mmm Of Fl (Health Advantage Plan)	$1,233	1154%
United Ppo	$1,270	1189%
Sunshine State Health Plan	$1,394	1305%
Aetna	$1,608	1505%
Blis	$1,876	1756%
District Cares	$2,680	2509%
Plotkin Health	$2,680	2509%
Prime Health Sherriff	$2,680	2509%
Medica Healthcare	$3,162	2960%
Multiplan	$4,020 - $4,556	3764%
Evernorth Bh	$4,288	4015%

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 $5,360.
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 Jfk 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.