CMS Price Transparency Data

Ultrasound, thyroid and neck

Facility: UPMC Presbyterian Shadyside

Billing Code: 76536 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76536
Insurance Median: $987
Cash Discount Price: $1,263
vs. Medicare Baseline: 9.24x Medicare

The contracted insurance negotiated median rate for a Ultrasound, thyroid and neck at UPMC Presbyterian Shadyside is $987. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,263. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.24x the Medicare baseline. Located in 200 Lothrop Street, Pittsburgh, PA.

Cash / Self-Pay

$1,263

Average discount available for prompt cash payment at this facility.

Insurance Median

$987

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: $1,263 (1182%)

Insurance Median: $987 (924%)

Cash: $1,263 (1182% of Medicare)

Ins. Median: $987 (924% 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 924% of the Medicare baseline (a markup of 824%). 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	$61 - $109	57%
Upmc Health Plan	$84 - $987	79%
Blue Cross Blue Shield	$97 - $643	91%
Aetna	$99 - $526	93%
Amerihealth Caritas	$109 - $121	102%
Cigna	$109	102%
Highmark Wholecare (Prev Gateway)	$109 - $1,052	102%
Pa Health & Wellness	$109 - $130	102%
Health Partners Plans (Jefferson Health Plan)	$115	108%
Geisinger	$119	111%
Upmc Work Partners	$211	198%
Multiplan	$246 - $1,684	230%
Preferred Healthcare System	$1,368	1281%
Coventry/First Health	$1,474	1380%
Fidelis	$1,579	1478%
Intergroup	$1,579 - $1,789	1478%
Health Coalition Partners	$1,684	1577%
Private Health Care Systems	$1,684	1577%
Selectcare	$1,684	1577%
Health Payors Organization	$1,789	1675%
Humana	$1,789	1675%

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 $1,263.
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 UPMC Presbyterian Shadyside 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.