CMS Price Transparency Data

Ultrasound, thyroid and neck

Facility: Saint Joseph Regional Medical Center

Billing Code: 76536 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76536
  • Insurance Median: $391
  • Cash Discount Price: $658
  • vs. Medicare Baseline: 3.66x Medicare
The contracted insurance negotiated median rate for a Ultrasound, thyroid and neck at Saint Joseph Regional Medical Center is $391. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $658. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.66x the Medicare baseline. Located in 5215 Holy Cross Pkwy, Mishawaka, IN.
Cash / Self-Pay
$658

Average discount available for prompt cash payment at this facility.

Insurance Median
$391

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: $658 (616%)
Insurance Median: $391 (366%)
Cash: $658 (616% of Medicare)
Ins. Median: $391 (366% 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 366% of the Medicare baseline (a markup of 266%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 $57 - $658 53%
Blue Cross Blue Shield $57 - $391 53%
Medicaid / KanCare $57 - $256 53%
UnitedHealthcare $57 - $645 53%
Medicare (plans) $111 - $113 104%
Meridian Complete $111 104%
Pace-Trinity Health $111 104%
County Coroner $115 108%
Provider Partners Health Plan Of Indiana $122 114%
Auxiant $166 - $840 155%
Physicians Health Plan Northern Indiana Health Insurance $166 - $334 155%
St Joseph County Hlth Dpt $166 155%
Caresource $171 160%
Siho Insurance Services $177 166%
Key Benefit Administrator $199 - $630 186%
Allied Benefit Systems $210 - $658 197%
Custom Design Benefits $238 223%
Managed Health Services - Indiana $256 240%
Mdwise $256 240%
Hospice Of Marshall County $263 246%
Hospice Of St Joseph County $263 246%
Plain Church Group $273 256%
Blue Benefit Administrators Of Massachusetts $391 366%
Blue Care Network $391 366%
Blue Distinction Transplant $391 366%
Blue Shield - Ca $391 366%
Blue Shield - Id (Regence) $391 366%
Blue Shield - Ny Highmark Northeastern $391 366%
Blue Shield - Ny Highmark Western $391 366%
Blue Shield - Pa (Highmark) $391 366%
Blue Shield - Wa (Regence) $391 366%
Notre Dame Athletic Association $557 521%
Wc Notre Dame $557 521%
Luminare Health (Detroit) $577 - $607 540%
Encore Health $600 - $630 562%
Ameriben $607 568%
Indiana Criminal Justice Inst $630 590%
Western & Southern Financial Group $630 590%
Geha $645 604%
Healthscope $645 604%
Student Insurance Cma $645 604%
Cigna $648 607%
Group Administrators $648 607%
Health Partners $648 607%
Mvp $648 607%
Prairie States $648 607%
Priority Health $648 607%
Professional Benefit Administrators $648 607%
Sagamore Health Network $648 - $749 607%
Sisco Benefits $648 607%
Unified Group Services $648 607%
Asr Health Benefits $658 616%
Christian Brother Services $658 616%
Employee Benefit Management $658 616%
Medical Mutual $658 616%
Meritain $658 616%
Preferred One $658 616%
Rural Carrier Health Benefit Plan $658 616%
Webtpa $658 616%
Goshen Preferred Network $779 - $870 729%
Christian Brothers Holy Cross $810 758%
Signature Care $810 758%
Bankers Life Casualty $1,012 947%
Bureau Of Disability $1,012 947%
Wc Align Network $1,012 947%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 5215 Holy Cross Pkwy, Mishawaka, IN 46545
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals