CMS Price Transparency Data

Ultrasound, pelvis

Facility: HCA Florida Palms West Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $1,105
Cash Discount Price: $4,806
vs. Medicare Baseline: 10.35x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at HCA Florida Palms West Hospital is $1,105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,806. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.35x the Medicare baseline. Located in 13001 Southern Blvd, Loxahatchee, FL.

Cash / Self-Pay

$4,806

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,105

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: $4,806 (4500%)

Insurance Median: $1,105 (1035%)

Cash: $4,806 (4500% of Medicare)

Ins. Median: $1,105 (1035% 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 1035% of the Medicare baseline (a markup of 935%). 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 - $2,163	229%
Freedom Health	$413 - $769	387%
Optimum	$413	387%
Healthy Palm Beaches	$550	515%
Avmed	$625 - $2,403	585%
Simply Healthcare Plans	$625	585%
Molina	$913 - $1,298	855%
Humana	$1,009 - $1,634	945%
Health Sun Health Plan	$1,024	959%
Aids Healthcare	$1,057 - $5,767	990%
Corvel Corporation	$1,087	1018%
Mmm Of Fl (Health Advantage Plan)	$1,105	1035%
Careworks (Rockport)	$1,110	1039%
Prime Health	$1,110	1039%
United Ppo	$1,139	1066%
Sunshine State Health Plan	$1,250	1170%
Aetna	$1,442	1350%
Health Care District	$2,403	2250%
Palm Beach Juvenile Correction	$2,403	2250%
Plotkin Health	$2,403	2250%
Prime Health Sherriff	$2,403	2250%
Medica Healthcare	$2,787	2609%
Multiplan	$3,604 - $4,085	3374%

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 $4,806.
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 Palms West 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.