Ultrasound, thyroid and neck
Facility: Hospital District #6 Patterson Health Center
Billing Code: 76536 (CPT)
- CPT Billing Code: 76536
- Insurance Median: $540
- Cash Discount Price: $480
- vs. Medicare Baseline: 5.06x 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 506% of the Medicare baseline (a markup of 406%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $452 - $476 | 423% |
| UnitedHealthcare | $540 - $600 | 506% |
| Providers Care (Wppa)-All Plans | $1,050 | 983% |
Consumer Guidance & Cost Commentary
For the CPT code 76536 (Ultrasound, thyroid and neck), the facility's cash median rate of $480.00 is lower than the negotiated rates paid by major payers like UnitedHealthcare ($540.00) and Providers Care ($1,050.00). This pricing structure highlights a common billing dynamic where commercial insurance contracts often result in higher out-of-pocket costs for patients with high-deductible plans compared to self-pay options. While the facility is a Critical Access Hospital in Anthony, KS, with a government ownership model, patients should verify if their specific insurance plan has a deductible that exceeds the cash price before scheduling, as paying out-of-pocket upfront can sometimes be more financially advantageous than waiting for insurance reimbursement.
It is important to distinguish between the facility's negotiated rates and the federal Medicare benchmark of $106.81 for this service. The data indicates a significant markup relative to the Medicare amount, which serves as the objective baseline for healthcare costs. Additionally, patients should be aware of the potential for balance billing if they receive care from out-of-network providers, though the No Surprises Act offers protections for emergency services at in-network facilities. To ensure accuracy, consumers should request a full itemized bill rather than accepting a summary invoice, as detailed statements allow for the identification of unbundled codes or services not rendered, which can significantly reduce the final amount owed.