CMS Price Transparency Data

Ultrasound, pelvis

Facility: South Miami Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $858
Cash Discount Price: $1,213
vs. Medicare Baseline: 8.03x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at South Miami Hospital is $858. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,213. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.03x the Medicare baseline. Located in 6200 Sw 73Rd St, Miami, FL.

Cash / Self-Pay

$1,213

Average discount available for prompt cash payment at this facility.

Insurance Median

$858

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: $1,213 (1136%)

Insurance Median: $858 (803%)

Cash: $1,213 (1136% of Medicare)

Ins. Median: $858 (803% 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 803% of the Medicare baseline (a markup of 703%). 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
Amerigroup	$102	95%
Medicaid / KanCare	$102 - $112	95%
UnitedHealthcare	$107 - $1,945	100%
Wellcare	$107	100%
Sunshine State	$108	101%
Medicare (plans)	$109 - $147	102%
Aetna	$110 - $1,556	103%
Vista	$110	103%
Blue Cross Blue Shield	$113 - $1,260	106%
Medica Health Plan	$117	110%
Humana	$119	111%
Avmed	$120 - $963	112%
Leon Medical	$120	112%
Cigna	$124 - $1,556	116%
Non Contracted	$656 - $714	614%
Amerihealth	$805 - $875	754%
International	$1,162 - $1,264	1088%
Dimension Health Plan	$1,341 - $1,750	1256%
Affordable	$1,520 - $1,653	1423%
Phcs	$1,609 - $1,750	1506%
Quality Health	$1,609 - $1,750	1506%

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 $1,213.
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 South Miami 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.