CMS Price Transparency Data

Ultrasound, thyroid and neck

Facility: St James Hospital

Billing Code: 76536 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76536
Insurance Median: $62
Cash Discount Price: $113
vs. Medicare Baseline: 0.58x Medicare

The contracted insurance negotiated median rate for a Ultrasound, thyroid and neck at St James Hospital is $62. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $113. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.58x the Medicare baseline. Located in 411 Canisteo Street, Hornell, NY.

Cash / Self-Pay

$113

Average discount available for prompt cash payment at this facility.

Insurance Median

$62

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: $113 (106%)

Insurance Median: $62 (58%)

Cash: $113 (106% of Medicare)

Ins. Median: $62 (58% 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
Medicaid / KanCare	$15 - $231	14%
Blue Cross Blue Shield	$18 - $312	17%
Fidelis 5155	$18 - $89	17%
UnitedHealthcare	$18 - $140	17%
Medicare (plans)	$24 - $154	22%
Mvp 2900	$25 - $303	23%
Aetna	$26 - $140	24%
Excellus 2201	$26 - $105	24%
Molina Healthcare 1723	$30 - $68	28%
Cigna	$34 - $314	32%
Capital District Physicians Health Plan (Cdphp) 5149	$67 - $274	63%
Humana	$140	131%
Empire Plan 5179	$295	276%

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 $113.
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 St James 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.