CMS Price Transparency Data

Ultrasound, thyroid and neck

Facility: Kootenai Health

Billing Code: 76536 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76536
Insurance Median: $103
Cash Discount Price: $480
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Ultrasound, thyroid and neck at Kootenai Health is $103. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $480. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.96x the Medicare baseline. Located in 2003 Kootenai Health Way, Coeur D'Alene, ID.

Cash / Self-Pay

$480

Average discount available for prompt cash payment at this facility.

Insurance Median

$103

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: $480 (449%)

Insurance Median: $103 (96%)

Cash: $480 (449% of Medicare)

Ins. Median: $103 (96% 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.

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
Coordinated Care Of Washington	$16 - $68	15%
Molina Healthcare Of Idaho	$16 - $237	15%
Molina Healthcare Of Washington	$16 - $68	15%
Blue Cross Blue Shield	$25 - $618	23%
Humana	$25 - $108	23%
Magellan	$25 - $98	23%
Premera	$25 - $396	23%
Regence Blue Shield Of Idaho	$25 - $108	23%
UnitedHealthcare	$25 - $576	23%
Wellpoint	$25 - $98	23%
Pacificsource	$26 - $524	24%
Aetna	$27 - $531	25%
Group Health/Kaiser	$36 - $389	34%
Mountain Health Co-Op	$496	464%
Cigna	$524 - $532	491%
Interwest Health	$544	509%
First Choice Health (Ameriben)	$546 - $554	511%

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 $480.
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 Kootenai Health 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.