CMS Price Transparency Data

Ultrasound, pelvis

Facility: HCA Florida North Florida Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $1,134
Cash Discount Price: $3,109
vs. Medicare Baseline: 10.62x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at HCA Florida North Florida Hospital is $1,134. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,109. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.62x the Medicare baseline. Located in 6500 W Newberry Rd, Gainesville, FL.

Cash / Self-Pay

$3,109

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,134

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: $3,109 (2911%)

Insurance Median: $1,134 (1062%)

Cash: $3,109 (2911% of Medicare)

Ins. Median: $1,134 (1062% 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 1062% of the Medicare baseline (a markup of 962%). 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 - $1,833	229%
Avmed	$257 - $2,037	241%
Simply	$330 - $627	309%
Molina Healthcare	$408 - $1,303	382%
Humana	$429 - $815	402%
Sunshine State Health Plan	$547 - $1,039	512%
Aetna	$644 - $1,222	603%
Plotkin Health	$1,073 - $2,037	1005%
Prime Health Sheriff	$1,073 - $2,037	1005%
Corvel Corporation	$1,093	1023%
Prime Health	$1,116	1045%
Careworks (Rockport Community)	$1,151	1078%
Corizon Phs	$1,287 - $2,444	1205%
Multiplan	$1,673 - $3,462	1566%
Evernorth	$1,716 - $3,258	1607%
Evolutions Healthcare	$1,824 - $3,462	1708%
Ppo Next	$1,824 - $3,462	1708%
Novanet	$1,931 - $3,666	1808%
Beacon Health Options	$2,145 - $4,073	2008%

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 $3,109.
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 North Florida 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.