Ultrasound, thyroid and neck
Facility: Phillips County Hospital
Billing Code: 76536 (CPT)
- CPT Billing Code: 76536
- Insurance Median: $610
- Cash Discount Price: $541
- vs. Medicare Baseline: 5.71x 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 571% of the Medicare baseline (a markup of 471%). 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 | $481 - $538 | 450% |
| UnitedHealthcare | $488 - $664 | 457% |
| Medicaid / KanCare | $610 - $664 | 571% |
| Health Partners-All Plans | $610 - $664 | 571% |
Consumer Guidance & Cost Commentary
For the CPT code 76536 (Ultrasound, thyroid and neck) at Phillips County Hospital, the cash median price is $541.00, which is lower than the facility's negotiated rates of $610.00 and the gross charge of $637.00. While the facility is a Critical Access Hospital in Phillipsburg, KS, with a government-local ownership structure, patients should be aware that insurance negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. In this case, the cash price is notably lower than the median negotiated amount, suggesting that paying out-of-pocket or utilizing a prompt-pay discount could result in immediate savings compared to standard insurance billing, particularly for those with high-deductible plans who may face higher out-of-pocket costs if their insurance allows a rate above the cash price.
The Medicare benchmark for this service is $106.81, which serves as a baseline for evaluating the facility's pricing markup; commercial rates are typically higher than this federal rate to cover provider costs and administrative expenses. Although the data does not include specific state or county average comparisons for this exact code, the significant difference between the Medicare rate and the cash price highlights the potential for substantial savings when negotiating directly with the hospital. Patients are encouraged to request an itemized billing audit to ensure no unbundled codes or services not rendered are included in the final invoice, as over 80% of hospital bills contain errors that can be corrected. Additionally, since the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, patients should verify their network status and dispute any unexpected bills rather than paying immediately out of fear of credit damage.