CMS Price Transparency Data

Ultrasound, thyroid and neck

Facility: Kaleida Health

Billing Code: 76536 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76536
Insurance Median: $137
Cash Discount Price: $363
vs. Medicare Baseline: 1.28x Medicare

The contracted insurance negotiated median rate for a Ultrasound, thyroid and neck at Kaleida Health is $137. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $363. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.28x the Medicare baseline. Located in 100 High Street, Buffalo, NY.

Cash / Self-Pay

$363

Average discount available for prompt cash payment at this facility.

Insurance Median

$137

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: $363 (340%)

Insurance Median: $137 (128%)

Cash: $363 (340% of Medicare)

Ins. Median: $137 (128% 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
Molina Healthcare Of New York, Inc.	$23	22%
Highmark Wny	$24	22%
Meritain Health	$40	37%
Univera Healthcare	$68	64%
Independent Health Association	$76 - $249	71%
Independent Health Association - Wchob	$79 - $249	74%
Blue Cross Blue Shield	$89 - $487	83%
Univera	$89 - $182	83%
Univera - Wchob	$89 - $177	83%
Ghi/Emblem Health	$91 - $176	85%
Ghi/Emblem Health - Wchob	$91 - $114	85%
Aetna	$95 - $138	89%
Magnacare	$95 - $122	89%
Magnacare - Wchob	$95 - $122	89%
Tricare	$124	116%
Wellcare	$136	127%
Fidelis	$141	132%
UnitedHealthcare	$142	133%
Cigna	$153 - $185	143%

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 $363.
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 Kaleida 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.