CMS Price Transparency Data

Ultrasound, pelvis

Facility: HCA Florida Aventura Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $856
Cash Discount Price: $3,294
vs. Medicare Baseline: 8.01x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at HCA Florida Aventura Hospital is $856. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,294. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.01x the Medicare baseline. Located in 20900 Biscayne Blvd, Aventura, FL.

Cash / Self-Pay

$3,294

Average discount available for prompt cash payment at this facility.

Insurance Median

$856

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: $3,294 (3084%)

Insurance Median: $856 (801%)

Cash: $3,294 (3084% of Medicare)

Ins. Median: $856 (801% 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 801% of the Medicare baseline (a markup of 701%). 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 - $1,482	229%
Freedom Health	$283 - $527	265%
Optimum	$283	265%
Avmed	$395 - $1,647	370%
Simply Healthcare Plans	$428	401%
Molina	$560 - $889	524%
Humana	$692 - $1,120	648%
Health Sun Health Plan	$702	657%
Aids Healthcare	$725 - $3,953	679%
Mmm Of Fl (Health Advantage Plan)	$758	710%
United Ppo	$781	731%
Sunshine State Health Plan	$856	801%
Aetna	$988	925%
Corvel Corporation	$1,129	1057%
Careworks (Rockport)	$1,152	1079%
Prime Health	$1,152	1079%
Plotkin Health	$1,647	1542%
Prime Health Sherriff	$1,647	1542%
Medica Healthcare	$1,911	1789%
Multiplan	$2,470 - $2,800	2313%
Evernorth Bh	$2,635	2467%

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 $3,294.
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 Aventura 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.