CMS Price Transparency Data

Ultrasound, pelvis

Facility: HCA Florida Poinciana Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $1,449
Cash Discount Price: $5,004
vs. Medicare Baseline: 13.57x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at HCA Florida Poinciana Hospital is $1,449. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,004. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 13.57x the Medicare baseline. Located in 325 Cypress Pkwy, Kissimmee, FL.

Cash / Self-Pay

$5,004

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,449

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: $5,004 (4685%)

Insurance Median: $1,449 (1357%)

Cash: $5,004 (4685% of Medicare)

Ins. Median: $1,449 (1357% 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 1357% of the Medicare baseline (a markup of 1257%). 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 - $2,338	229%
Freedom Health	$346 - $374	324%
Optimum	$346 - $374	324%
Avmed	$385 - $2,598	360%
Simply	$741 - $800	694%
Molina Healthcare	$914 - $1,403	856%
Corvel Corporation	$1,037	971%
Prime Health	$1,059	991%
Careworks (Rockport Community)	$1,091	1021%
Sunshine State Health Plan	$1,227 - $1,325	1149%
Humana	$1,347 - $1,455	1261%
Aetna	$1,443 - $1,559	1351%
Plotkin Health	$2,406 - $2,598	2253%
Prime Health Sheriff	$2,406 - $2,598	2253%
Multiplan	$3,608 - $4,417	3378%

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 $5,004.
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 Poinciana 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.