CMS Price Transparency Data

Ultrasound, pelvis

Facility: HCA Florida Englewood Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $1,359
Cash Discount Price: $5,328
vs. Medicare Baseline: 12.72x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at HCA Florida Englewood Hospital is $1,359. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,328. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 12.72x the Medicare baseline. Located in 700 Medical Blvd, Englewood, FL.

Cash / Self-Pay

$5,328

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,359

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: $5,328 (4988%)

Insurance Median: $1,359 (1272%)

Cash: $5,328 (4988% of Medicare)

Ins. Median: $1,359 (1272% 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 1272% of the Medicare baseline (a markup of 1172%). 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 - $2,414	229%
Access 2 Healthcare Physicians Freedom Optimum Group Members	$249 - $252	233%
Access 2 Healthcare Physicians Freedom Health	$381 - $386	357%
Access 2 Healthcare Physicians Optimum	$381 - $386	357%
Freedom Health Care	$413 - $418	387%
Optimum Healthcare	$413 - $418	387%
Avmed	$423 - $1,341	396%
Simply Healthcare	$815 - $826	763%
Molina	$1,005 - $1,449	941%
Corvel Corporation	$1,051	984%
Rockport Healthcare Group	$1,051	984%
Prime Health	$1,073	1005%
Sunshine State Health Plan	$1,349 - $1,368	1263%
Humana	$1,482 - $1,502	1388%
Aetna	$1,587 - $1,609	1486%
Behealthy America	$2,064 - $2,092	1932%
Evolutions Healthcare Systems	$2,646 - $4,936	2477%
Healthcare Sarasota	$2,646 - $2,682	2477%
Plotkin Health	$2,646 - $2,682	2477%
Prime Health Sheriff	$2,646 - $2,682	2477%
Multiplan	$3,969 - $4,560	3716%

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 $5,328.
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 Englewood 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.