CMS Price Transparency Data

Ultrasound, pelvis

Facility: HCA Florida Northwest Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $1,298
Cash Discount Price: $4,993
vs. Medicare Baseline: 12.15x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at HCA Florida Northwest Hospital is $1,298. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,993. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 12.15x the Medicare baseline. Located in 2801 N State Rd 7, Margate, FL.

Cash / Self-Pay

$4,993

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,298

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: $4,993 (4675%)

Insurance Median: $1,298 (1215%)

Cash: $4,993 (4675% of Medicare)

Ins. Median: $1,298 (1215% 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 1215% of the Medicare baseline (a markup of 1115%). 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 - $2,247	229%
Freedom Health	$429 - $799	402%
Optimum	$429	402%
Avmed	$649 - $2,496	608%
Simply Healthcare Plans	$649	608%
Molina	$949 - $1,348	888%
Humana	$1,049 - $1,698	982%
Health Sun Health Plan	$1,064	996%
Corvel Corporation	$1,138	1065%
Mmm Of Fl (Health Advantage Plan)	$1,148	1075%
Careworks (Rockport)	$1,162	1088%
Prime Health	$1,162	1088%
United Ppo	$1,183	1108%
Sunshine State Health Plan	$1,318	1234%
Aetna	$1,498	1402%
Blis	$1,748	1637%
Plotkin Health	$2,496	2337%
Prime Health Sherriff	$2,496	2337%
Medica Healthcare	$2,896	2711%
Multiplan	$3,745 - $4,244	3506%

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 $4,993.
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 Northwest 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.