CMS Price Transparency Data

Ultrasound, thyroid and neck

Facility: HSHS St Elizabeth's Hospital

Billing Code: 76536 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76536
Insurance Median: $136
Cash Discount Price: $1,053
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Ultrasound, thyroid and neck at HSHS St Elizabeth's Hospital is $136. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,053. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.27x the Medicare baseline. Located in One St Elizabeth Boulevard, O Fallon, IL.

Cash / Self-Pay

$1,053

Average discount available for prompt cash payment at this facility.

Insurance Median

$136

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: $1,053 (986%)

Insurance Median: $136 (127%)

Cash: $1,053 (986% of Medicare)

Ins. Median: $136 (127% 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
Aetna	$44 - $1,029	41%
Blue Cross Blue Shield	$44 - $1,462	41%
Claim Doc	$44 - $297	41%
Clear Spring Health Of Illinois	$44 - $119	41%
Health Alliance Medical Plans	$44 - $1,243	41%
Health Partners	$44 - $119	41%
Hopetrust	$44 - $285	41%
Humana	$44 - $119	41%
Molina Healthcare	$44 - $124	41%
Naphcare	$44 - $257	41%
Sae Hospice	$44 - $119	41%
UnitedHealthcare	$44 - $1,462	41%
Meridian Health Plan	$52 - $104	49%
Celtic Insurance Company	$119 - $237	111%
Amish Community	$409	383%
Cigna	$916 - $1,462	858%
Wellfirst	$941	881%
First Health	$1,088	1019%
Healthlink	$1,162 - $1,462	1088%
Caterpillar, Inc.	$1,174	1099%
Consociate Group	$1,287	1205%
Choicecare	$1,316	1232%
Healthcare Finest Network (Hfn)	$1,316	1232%
Multiplan/Phcs	$1,316	1232%
Provider Network Of America	$1,316	1232%
City Of Springfield	$1,462	1369%
Current Health Solutions	$1,462	1369%
Healthscope	$1,462	1369%
Illinois Breast And Cervical Cancer Program	$1,462	1369%
Interplan	$1,462	1369%
Live360	$1,462	1369%
Wexford	$1,462	1369%

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 $1,053.
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 HSHS St Elizabeth's Hospital 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.