Ultrasound, thyroid and neck
Facility: Decatur Health
Billing Code: 76536 (CPT)
- CPT Billing Code: 76536
- Insurance Median: $681
- Cash Discount Price: $803
- vs. Medicare Baseline: 6.38x 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 638% of the Medicare baseline (a markup of 538%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $536 | 502% |
| UnitedHealthcare | $545 - $681 | 510% |
| Humana | $550 | 515% |
| Blue Cross Blue Shield | $619 | 580% |
| Aetna | $803 - $893 | 752% |
| Midlands Choice- All Plans | $803 | 752% |
| Medicaid / KanCare | $902 | 844% |
Consumer Guidance & Cost Commentary
For the ultrasound of the thyroid and neck at Decatur Health in Oberlin, KS, the cash median price is $803.00, which aligns with the facility's negotiated rate for Aetna and Midlands Choice. While the gross charge listed is $893.00, commercial payers like UnitedHealthcare and Aetna have negotiated rates ranging from $545 to $893, with a median negotiated amount of $681.00. It is important to note that cash payments can sometimes be more cost-effective for patients with high-deductible plans if their insurance negotiated rate exceeds the cash price, though in this case, the cash rate is slightly higher than the median negotiated rate. Patients should always verify their specific plan's allowed amount before scheduling, as in-network rates vary significantly by carrier.
When evaluating the cost of this service, it is crucial to compare rates against the Medicare benchmark rather than the facility's gross chargemaster. The Medicare amount for this procedure is $106.81, which serves as the objective baseline for evaluating pricing markups. Commercial rates, including the cash price of $803.00, represent a significant markup over this federal standard, reflecting the administrative costs and contract dynamics inherent in commercial insurance. To potentially reduce out-of-pocket expenses, patients should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can offer immediate fee reductions for upfront payment. Additionally, requesting a detailed, itemized bill is recommended to identify any errors or unbundled charges, as over 80% of hospital bills contain discrepancies that can be corrected through a formal written audit.