CMS Price Transparency Data

Ultrasound, thyroid and neck

Facility: Adventist Health Clearlake

Billing Code: 76536 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76536
Insurance Median: $530
Cash Discount Price: $342
vs. Medicare Baseline: 4.96x Medicare

The contracted insurance negotiated median rate for a Ultrasound, thyroid and neck at Adventist Health Clearlake is $530. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $342. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.96x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$342

Average discount available for prompt cash payment at this facility.

Insurance Median

$530

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: $342 (320%)

Insurance Median: $530 (496%)

Cash: $342 (320% of Medicare)

Ins. Median: $530 (496% 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 496% of the Medicare baseline (a markup of 396%). 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
Bc Managed Mcal	$86	81%
Medi-Cal	$86	81%
Blue Shield Mcr Adv	$131 - $268	123%
Kaiser Mcr Adv	$131 - $268	123%
Tricare	$131 - $268	123%
Blue Cross Blue Shield	$136 - $476	127%
UnitedHealthcare	$144 - $1,066	135%
Ah Employee Health Plan - All Plans	$262 - $537	245%
Aetna	$466 - $955	436%
Western Growers- All Plans	$467 - $958	437%
Blue Shield Epn - All Other Plans	$478 - $982	448%
Blue Shield Non-Epn	$478 - $982	448%
First Health- All Plans	$498 - $1,022	466%
Healthnet- All Plans	$511 - $1,048	478%
Foundation- All Plans	$530 - $1,086	496%
Health Mgmt Network- All Plans	$530 - $1,086	496%
Humana	$530 - $1,086	496%
Phcs- All Plans	$530 - $1,086	496%
Cigna	$561 - $1,150	525%
Interplan- All Plans	$561 - $1,150	525%
Kaiser- All Other Plans	$561 - $1,150	525%
Three Rivers Provider Network- All Plans	$561 - $1,150	525%
Partnership Mcal - All Plans	$1,028 - $2,109	962%

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 $342.
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 Clearlake 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.