Ultrasound, thyroid and neck
Facility: Nemaha Valley Community Hospital
Billing Code: 76536 (CPT)
- CPT Billing Code: 76536
- Insurance Median: $332
- Cash Discount Price: $495
- vs. Medicare Baseline: 3.11x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 311% of the Medicare baseline (a markup of 211%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $37 - $731 | 35% |
| Humana | $37 - $378 | 35% |
| Va Ccn - All Plans | $37 - $378 | 35% |
| Celtic Comm Exch - All Plans | $41 - $416 | 38% |
| Partners Direct Health - All Plans | $44 - $447 | 41% |
| Multiplan - All Plans | $76 - $774 | 71% |
| Midlands Choice - All Plans | $80 - $817 | 75% |
| Health Partners - All Plans | $80 - $817 | 75% |
| Blue Cross Blue Shield | $481 | 450% |
Consumer Guidance & Cost Commentary
For the CPT code 76536 (Ultrasound, thyroid and neck) at Nemaha Valley Community Hospital in Seneca, KS, the cash price of $495.00 is lower than the facility's gross charge of $550.00. While the hospital's negotiated rates with major payers like Aetna and Humana range from $37 to $731, the cash price can be a more affordable option for patients with high-deductible plans or those without insurance, as it avoids the administrative markup often found in commercial contracts. It is important to note that the facility's cash rate is significantly higher than the state average for this procedure, which is reflected in the median paid amount of $332.00 across various payers. Patients should verify their specific plan's allowed amount before scheduling, as some commercial rates may exceed the cash price, making self-pay or prompt-pay discounts the most economical choice.
The Medicare benchmark for this service is $106.81, which serves as a critical baseline for evaluating the facility's pricing markup. The hospital's cash rate of $495.00 represents a substantial increase over the Medicare amount, illustrating the typical commercial pricing structure in Critical Access Hospitals. To ensure you are not overcharged, we recommend requesting an itemized billing audit to review every line item and confirm that no services were unbundled or double-billed. Additionally, if you encounter a balance bill from an out-of-network provider, such as an emergency physician or lab service, you may be protected under the No Surprises Act, which prohibits balance billing for non-emergency services at in-network facilities. Always dispute any unexpected bills