CMS Price Transparency Data

Ultrasound, thyroid and neck

Facility: Hospital for Special Surgery

Billing Code: 76536 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76536
Insurance Median: $348
Cash Discount Price: $309
vs. Medicare Baseline: 3.26x Medicare

The contracted insurance negotiated median rate for a Ultrasound, thyroid and neck at Hospital for Special Surgery is $348. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $309. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.26x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$309

Average discount available for prompt cash payment at this facility.

Insurance Median

$348

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: $309 (289%)

Insurance Median: $348 (326%)

Cash: $309 (289% of Medicare)

Ins. Median: $348 (326% 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 326% of the Medicare baseline (a markup of 226%). 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
UnitedHealthcare	$20 - $771	19%
Fidelis	$22 - $23	21%
Emblem	$29 - $39	27%
Metro Plus	$29 - $30	27%
Blue Cross Blue Shield	$30 - $771	28%
Horizon	$47	44%
Nyship	$52	49%
Cigna	$59 - $277	55%
Aetna	$66 - $771	62%
Fidelis Essential [1323]	$68	64%
Connecticare [1039]	$224 - $771	210%
Emblem Health [1043]	$224 - $520	210%
Apwu [1016]	$235 - $277	220%
Nalc [1090]	$235 - $277	220%
Qualcare [1101]	$235 - $277	220%
Wellfleet [1361]	$235 - $277	220%
Christian Brothers [1034]	$339 - $771	317%
Meritain Health [1085]	$339 - $771	317%
Nippon Life [1092]	$339 - $771	317%
Webtpa [1356]	$339 - $771	317%
Affinity By Molina Health Plan [1005]	$344 - $771	322%
Oxford [1096]	$422 - $544	395%
Student Resources [1103]	$520 - $671	487%
Harvard Pilgrim [1057]	$598 - $771	560%
Geha [1053]	$671	628%
Medicare (plans)	$771	722%

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 $309.
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 Hospital for Special Surgery 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.