CMS Price Transparency Data

Ultrasound, pelvis

Facility: HCA Florida South Shore Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $1,212
Cash Discount Price: $4,849
vs. Medicare Baseline: 11.35x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at HCA Florida South Shore Hospital is $1,212. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,849. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.35x the Medicare baseline. Located in 4016 Sun City Center Blvd, Sun City Center, FL.

Cash / Self-Pay

$4,849

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,212

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: $4,849 (4540%)

Insurance Median: $1,212 (1135%)

Cash: $4,849 (4540% of Medicare)

Ins. Median: $1,212 (1135% 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 1135% of the Medicare baseline (a markup of 1035%). 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
Access 2 Healthcare Physicians Freedom Optimum Group Members	$227 - $229	213%
United	$245 - $2,192	229%
Access 2 Healthcare Physicians Freedom Health	$348 - $351	326%
Access 2 Healthcare Physicians Optimum	$348 - $351	326%
Freedom Health Care	$376 - $380	352%
Optimum Healthcare	$376 - $380	352%
Avmed	$386 - $1,218	361%
Simply Healthcare	$743 - $750	696%
Molina	$917 - $1,315	859%
Corvel Corporation	$1,051	984%
Rockport Healthcare Group	$1,051	984%
Prime Health	$1,073	1005%
Sunshine State Health Plan	$1,231 - $1,242	1153%
Humana	$1,351 - $1,364	1265%
Aetna	$1,448 - $1,461	1356%
Plotkin Health	$2,413 - $2,436	2259%
Prime Health Sheriff	$2,413 - $2,436	2259%
Evolutions Healthcare Systems	$2,655 - $4,482	2486%
Multiplan	$3,620 - $4,141	3389%

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 $4,849.
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 South Shore 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.