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Hospital Profile Children's Hospital Voluntary non-profit - Private 130 Beds · urban Updated: 3/10/2026

Nemours Childrens Hospital, Florida

6535 Nemours Pkwy, Orlando, FL 32827 · 85 Priced Procedures

CMS Overall Rating No CMS Rating
Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.High Markup · Shop Alternatives
2.02×vs. Fair Market Price
Position vs. 1.00× Fair Price+102% Above Fair Price 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

Typical commercial prices here are +102% above the fair benchmark (2.02×) even after accounting for local nurse/doctor wages and patient complexity.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).54/100 · Caution
54/100Self-Pay Cash Beats Insurance 1% of the Time
File Completeness66Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic41Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment76Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing80Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount8Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.High-Markup · Check Safety
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety ScoreNot ScoredComposite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

Behavioral Pricing FingerprintUpper-Quartile Spread · +205% Tail Jump

Wide Procedure Spread · Upper-Quartile Skew Pricer

Nemours Childrens Hospital, Florida prices routine shoppable procedures at 3.9× Medicare (median 1.37× Fair BaseRate) while upper-quartile commercial rates jump +205% to 4.18× Fair BaseRate. Self-pay cash discounts and comparing specific CPT procedure codes before scheduling yield the strongest savings.

#159 of 165 in FL · 95th State Percentile#3,083 of 3,385 in U.S. · 91st National Percentile
Advantage

Where They're Good (Patient & Payer Edge)

  • Bottom-quartile procedures (Q25) price at 1.07× the peer BaseRate benchmark
  • Self-pay cash beats commercial insurance on 1% of shoppable procedures (25/100 Cash Honesty)
  • CMS clinical safety score (54/100 safety score) with 72% patient recommendation
  • IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (41.0% AGB cap)
Watchout

Where You Can Get Burned (Markup Traps)

  • Outpatient surgery & OR suites carry a 1.6× markup over Medicare rates
  • Commercial insurance median sits at 1.37× Fair BaseRate (3.9× Medicare), so insured patients should always compare the self-pay cash price before paying.
  • Upper-quartile procedures (Q75 4.18×) jump +205% above the median procedure ratio (Q50 1.37×)
  • Consolidated metro market (HHI 2,354) limits in-network hospital competition (Moderately Concentrated (1,500–2,500))
Front-Door ShoppableElective / Imaging
3.9× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER0.36× Divergence
1.4× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+205% Upper Tail
Q25 1.07× · Q50 1.37× · Q75 4.18×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.
Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×
Front-Door Shoppable CareFront-Door Shoppable
3.9× MedicareElevated
Outpatient Surgery & ORBack-Door Captive
1.6× MedicareGood
Diagnostic Imaging (CT/MRI)Front-Door Shoppable
4.7× MedicareWatchout
Back-Door Captive ER VisitsBack-Door Captive
5.7× MedicareWatchout
Inpatient Lab & PathologyBack-Door Captive
5.0× MedicareWatchout
Specialty & Infusion Drugs (J-Codes)Back-Door Captive
1.5× MedicareGood
Self-Pay Cash Honesty & 501(r)Integrity & Outcomes
1% Cash Edge · 25/100Watchout
CMS Clinical Safety & Star ValueIntegrity & Outcomes
3 CMS · 54/100Elevated

Procedure Prices at Nemours Childrens Hospital, Florida

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 85 published procedures.

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Audit a Bill & 501(r) Cap ↓
Procedure & Billing Code This Hospital vs. Fair
Spinal fusion, single level (inpatient stay)
MS-DRG Code: 451
 $55,655 1.8×
Sepsis treatment (inpatient stay)
MS-DRG Code: 871
 $24,044 1.3×
Digestive disorders treatment (inpatient stay)
MS-DRG Code: 392
 $8,251 1.0×
Upper endoscopy with biopsy
CPT Code: 43239
 $4,166 4.2×
MRI, brain (with and without contrast)
CPT Code: 70553
 $3,408 unverified
MRI, lower back (no contrast)
CPT Code: 72148
 $1,915 5.7×
CT scan, abdomen and pelvis (with contrast)
CPT Code: 74177
 $1,874 unverified
MRI, brain (no contrast)
CPT Code: 70551
 $1,803 5.3×
MRI, knee or other leg joint
CPT Code: 73721
 $1,803 unverified
CT scan, abdomen and pelvis (no contrast)
CPT Code: 74176
 $1,587 5.2×
CT scan, head (with and without contrast)
CPT Code: 70470
 $1,090 4.2×
Sleep study (overnight, in lab)
CPT Code: 95810
 $1,084 1.1×
CT scan, pelvis
CPT Code: 72192
 $927 5.7×
CT scan, chest (no contrast)
CPT Code: 71250
 $927 5.6×
CT scan, lower back (lumbar spine)
CPT Code: 72131
 $927 5.5×
CT scan, neck (cervical spine)
CPT Code: 72125
 $927 5.5×
CT scan, head (with contrast)
CPT Code: 70460
 $927 3.8×
Physical therapy (gait training)
CPT Code: 97116
 $844 unverified
CT scan, head (no contrast)
CPT Code: 70450
 $810 5.1×
CT scan, sinuses
CPT Code: 70486
 $810 4.9×
Physical therapy (functional capacity test)
CPT Code: 97750
 $779 20.5×
Echocardiogram (heart ultrasound)
CPT Code: 93306
 $676 1.2×
Ultrasound, leg veins (duplex)
CPT Code: 93970
 $631 2.3×
Blood transfusion
CPT Code: 36430
 $506 1.0×
Speech therapy (group session)
CPT Code: 92508
 $508 unverified
Showing top 25 high-impact procedures of 85 total
Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 41.0%

Audit a Bill or Quote at Nemours Childrens Hospital, Florida (Zero PHI Required)

CMS CCN: 103304
CPT 451
Fair BaseRate™ $30,775
Medicare Rate $23,504
Self-Pay Cash $116,796
Insurer Median $55,655
Pre-filled with Nemours Childrens Hospital, Florida’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $47,886 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $47,886

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (41.0% of gross = $47,886).

Step 2 · Cash vs. Insurance Arbitrage Published Cash: $116,796

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Nemours Childrens Hospital, Florida's published 45 CFR § 180 self-pay cash rate is $116,796 (vs. $55,655 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$86,021 Above Fair BaseRate

Negotiate Toward $30,775 Fair BaseRate ($23,504 Medicare)

Your bill ($116,796) is $86,021 above the denoised Fair BaseRate ($30,775) and 5.0× the $23,504 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
IRS Form 990 Schedule H & 26 U.S.C. § 501(r) 501(c)(3) Nonprofit Hospital

Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)

Free Care Eligibility BenchmarkUp to 200% FPL100% charity write-off income threshold
Discounted Care EligibilityUp to 400% FPLSliding-scale & AGB billing cap tier
Charity Care Share of ExpensesSee Schedule HNet community financial assistance reported
26 U.S.C. § 501(r)(5) AGB Benchmark Method: lookback_commercial_median

Hospital-Specific CMS HCRIS Benchmark (41.0% of gross charges)

Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.

Screen your household size, income, and itemized CPT codes against 2026 HHS Federal Poverty Guidelines: Calculate Your 501(r) Cap Above ↑
Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Higher-Quality, Above-Median Price Tier

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Nemours Childrens Hospital, Florida.

Price Index: 1.19× regional baseline
Quality: 54/100 CMS composite
Median Household Income$77,011U.S. Census ACS
Local Uninsured Share12.3%Regional ACS estimate
200% FPL (1 Person)$31,920Common free-care ceiling
400% FPL (Family of 4)$128,600Common AGB cap ceiling
45 CFR § 180 Primary-Source Lineage & Federal Verification VeriRate 54/100 · Caution CMS CCN 103304

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (CMS_45_CFR_180_FILING.json) Verify on CMS Medicare.gov (CCN 103304) ↗ CMS HCRIS Cost Reports ↗
Published MRF FileCMS_45_CFR_180_FILING.json
Publication / Vintage3/10/2026
Validated Rate Rows1,540 (CMS v3.0.0)
File Integrity DigestVerified · CCN 103304

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy