CMS Price Transparency Data

Ultrasound, thyroid and neck

Facility: Nemours Childrens Hospital, Florida

Billing Code: 76536 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76536
Insurance Median: $469
Cash Discount Price: $1,160
vs. Medicare Baseline: 4.39x Medicare

The contracted insurance negotiated median rate for a Ultrasound, thyroid and neck at Nemours Childrens Hospital, Florida is $469. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,160. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.39x the Medicare baseline. Located in 6535 Nemours Pkwy, Orlando, FL.

Cash / Self-Pay

$1,160

Average discount available for prompt cash payment at this facility.

Insurance Median

$469

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: $1,160 (1086%)

Insurance Median: $469 (439%)

Cash: $1,160 (1086% of Medicare)

Ins. Median: $469 (439% 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 439% of the Medicare baseline (a markup of 339%). 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
Tricare	$107	100%
Truli	$176 - $464	165%
Florida Blue	$195 - $708	183%
Cigna	$198 - $469	185%
Aetna	$342 - $510	320%
Avmed	$360	337%
UnitedHealthcare	$408	382%
Employers Health Network Fl	$464	434%
Evolutions Healthcare	$522	489%
Integra Administrative Group	$696	652%
Global Medical Management	$754	706%
Prime Health Services	$754	706%
Star Healthcare Network	$754	706%
Velocity	$870	815%
First Health Network	$905	847%
Pnoa	$928	869%
Seminole Tribe Of Fl	$928	869%
Private Healthcare Systems	$1,067	999%

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 $1,160.
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 Nemours Childrens Hospital, Florida 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.