Ultrasound, thyroid and neck
Facility: St Luke Hospital & Living Center
Billing Code: 76536 (CPT)
- CPT Billing Code: 76536
- Insurance Median: $377
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.53x 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 353% of the Medicare baseline (a markup of 253%). 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 | $377 | 353% |
| Humana | $377 | 353% |
| Bluestem Pace | $377 | 353% |
| Va Ccn | $377 | 353% |
| Kansas Department Of Health And Environment | $377 | 353% |
| Blue Cross Blue Shield | $377 | 353% |
| Ambetter / Centene | $381 | 357% |
Consumer Guidance & Cost Commentary
For the CPT code 76536, representing an ultrasound of the thyroid and neck, St Luke Hospital & Living Center in Marion, KS, has a gross charge of $739.00. While the facility's negotiated rates with seven major payers, including UnitedHealthcare and Humana, are set at $377.00, the Medicare benchmark for this service is significantly lower at $106.81. This indicates that the commercial negotiated rate is approximately 3.5 times the Medicare amount. Given that cash payments are often not listed in the data, patients with high-deductible plans should verify if paying cash upfront could result in a lower total cost than their insurance allowed amount, as hospitals frequently offer prompt-pay discounts to bypass administrative claim processing fees.
It is important to note that the facility is a Critical Access Hospital owned by a Government Hospital District, which may influence its pricing structure compared to private entities. Although the data does not provide specific cash or median paid figures for this service, consumers should proactively request a self-pay or prompt-pay discount before scheduling to avoid being billed the full negotiated rate. Additionally, because the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should ensure they receive an itemized bill to confirm all charges are accurate and that no unexpected ancillary services have been billed separately.