CMS Price Transparency Data

Ultrasound, thyroid and neck

Facility: Adventist Health St Helena

Billing Code: 76536 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76536
Insurance Median: $241
Cash Discount Price: $132
vs. Medicare Baseline: 2.26x Medicare

The contracted insurance negotiated median rate for a Ultrasound, thyroid and neck at Adventist Health St Helena is $241. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $132. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.26x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$132

Average discount available for prompt cash payment at this facility.

Insurance Median

$241

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: $132 (124%)

Insurance Median: $241 (226%)

Cash: $132 (124% of Medicare)

Ins. Median: $241 (226% 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 226% of the Medicare baseline (a markup of 126%). 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
Blue Shield Bh Mcr Adv	$29 - $139	27%
Blue Shield Mcr Adv	$29 - $139	27%
Kaiser Mcr Adv	$29 - $139	27%
Tricare	$29 - $139	27%
Ah Employee Health Plan - All Plans	$32 - $250	30%
Cigna	$35 - $1,656	33%
Interplan-All Plans	$35 - $1,346	33%
Kaiser-All Other Plans	$35 - $1,697	33%
Blue Shield Epn-All Other Plans	$36 - $975	34%
Blue Shield Non-Epn	$38 - $960	36%
Western Growers-All Plans	$43 - $1,097	40%
Medi-Cal	$60	56%
Phcs-All Plans	$64 - $1,138	60%
Va Medi-Cal	$86	81%
Health Management Network-All Plans	$99 - $1,760	93%
Three Rivers-All Plans	$104 - $1,863	97%
UnitedHealthcare	$126 - $1,320	118%
Blue Shield Behav Hlth	$128 - $932	120%
Va Mcr - All Other Plans	$139	130%
Aetna	$143 - $595	134%
Healthnet-All Plans	$174 - $1,269	163%
Choicecare-All Plans	$199 - $1,449	186%
Beech Street-All Plans	$213 - $1,552	199%
Galaxy Network-All Plans	$256 - $1,863	240%
Blue Cross Blue Shield	$353 - $470	330%

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 $132.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 76536.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health St Helena is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 76536.
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.