CMS Price Transparency Data

Ultrasound, pelvis

Facility: HCA Florida Orange Park Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $1,563
Cash Discount Price: $4,479
vs. Medicare Baseline: 14.63x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at HCA Florida Orange Park Hospital is $1,563. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,479. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 14.63x the Medicare baseline. Located in 2001 Kingsley Ave, Orange Park, FL.

Cash / Self-Pay

$4,479

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,563

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: $4,479 (4193%)

Insurance Median: $1,563 (1463%)

Cash: $4,479 (4193% of Medicare)

Ins. Median: $1,563 (1463% 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 1463% of the Medicare baseline (a markup of 1363%). 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
Optimum Healthcare	$238 - $515	223%
United	$245 - $2,759	229%
Avmed	$339 - $1,717	317%
Simply Healthcare	$435 - $944	407%
Positive Healthcare	$622 - $1,349	582%
Sunshine State Health Plan	$721 - $1,563	675%
Molina Healthcare	$763 - $1,655	714%
Aetna	$848 - $1,839	794%
Corvel Corporation	$1,035	969%
Prime Health	$1,057	990%
Humana	$1,159 - $2,514	1085%
Medicare (plans)	$1,272 - $2,759	1191%
Plotkin Health	$1,414 - $3,065	1324%
Multiplan	$2,205 - $5,211	2064%
Evernorth	$2,262 - $4,904	2118%
Evolutions Healthcare	$2,262 - $5,211	2118%
Ppo Next	$2,403 - $5,211	2250%
Novanet	$2,545 - $5,518	2383%

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 $4,479.
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 Orange Park 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.