CMS Price Transparency Data

Ultrasound, thyroid and neck

Facility: Lexington Memorial Hospital Inc

Billing Code: 76536 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76536
Insurance Median: $397
Cash Discount Price: $448
vs. Medicare Baseline: 3.72x Medicare

The contracted insurance negotiated median rate for a Ultrasound, thyroid and neck at Lexington Memorial Hospital Inc is $397. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $448. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.72x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$448

Average discount available for prompt cash payment at this facility.

Insurance Median

$397

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: $448 (419%)

Insurance Median: $397 (372%)

Cash: $448 (419% of Medicare)

Ins. Median: $397 (372% 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 372% of the Medicare baseline (a markup of 272%). 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
Amerihealth	$169 - $246	158%
Carolina Complete	$169	158%
Healthy Blue	$169	158%
Partners	$169	158%
UnitedHealthcare	$171 - $401	160%
Vaya	$171	160%
Wellcare	$171	160%
Alliance	$172	161%
Trillium	$174	163%
Medcost	$196 - $599	184%
Blue Cross Blue Shield	$247 - $397	231%
Aetna	$254 - $828	238%
Ambetter / Centene	$257	241%
Oscar	$287 - $394	269%
Cigna	$390 - $397	365%
Directnet	$530	496%
Healthgram Lexington Home Brands	$645	604%
Healthgram	$717	671%
Private Healthcare Systems	$735	688%
Beechstreet	$788	738%
Humana	$788	738%
Multiplan	$806	755%
National Provider Network	$806	755%

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 $448.
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 Lexington Memorial Hospital Inc 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.