Ultrasound, thyroid and neck
Facility: Holton Community Hospital
Billing Code: 76536 (CPT)
- CPT Billing Code: 76536
- Insurance Median: $643
- Cash Discount Price: $581
- vs. Medicare Baseline: 6.02x 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 602% of the Medicare baseline (a markup of 502%). 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 |
|---|---|---|
| UnitedHealthcare | $411 - $775 | 385% |
| Aetna | $411 - $775 | 385% |
| Humana | $415 | 389% |
| Kansas Superior Select - All Plans | $419 | 392% |
| Blue Cross Blue Shield | $476 | 446% |
| Preferred Health Freedom | $643 | 602% |
| Preferred Health Fn Select - All Other Plans | $643 | 602% |
| Preferred Health Professionals | $643 | 602% |
| Wppa Providers - All Plans | $736 | 689% |
| Medicaid / KanCare | $775 | 726% |
Consumer Guidance & Cost Commentary
For the CPT code 76536 (Ultrasound, thyroid and neck) at Holton Community Hospital in Holton, KS, the facility's cash median price is $581.00, which is notably higher than the state average of $419.00. While commercial insurance plans like UnitedHealthcare and Aetna negotiate rates up to the gross charge of $775.00, patients with high-deductible plans may find the cash price more affordable if their insurance negotiated rate exceeds $581.00. It is important to note that the facility's negotiated rate of $643.00 is significantly higher than the state average, suggesting that paying out-of-pocket or utilizing a self-pay classification could result in lower costs for some patients.
The facility's Medicare benchmarking rate of $106.81 serves as the objective baseline for evaluating pricing, revealing that the commercial negotiated rates are substantially marked up compared to the federal government's fixed reimbursement. Although the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that balance billing is generally prohibited for in-network services under the No Surprises Act. To ensure the lowest possible cost, consumers should request a prompt-pay discount before scheduling, which can reduce the bill by 20% to 50% by bypassing administrative claims processing, and always verify the specific allowed amount with the hospital prior to receiving care.