Ultrasound, thyroid and neck
Facility: Girard Medical Center
Billing Code: 76536 (CPT)
- CPT Billing Code: 76536
- Insurance Median: $312
- Cash Discount Price: $535
- vs. Medicare Baseline: 2.92x 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 292% of the Medicare baseline (a markup of 192%). 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 |
|---|---|---|
| Humana | $312 | 292% |
| Blue Cross Blue Shield | $312 - $481 | 292% |
| Aetna | $312 - $1,559 | 292% |
| Kansas Superior Select-All Plans | $312 | 292% |
| Medicare (plans) | $312 | 292% |
| Ambetter / Centene | $312 | 292% |
| UnitedHealthcare | $312 - $846 | 292% |
| Multiplan-All Plans | $824 | 771% |
| Uhhis-All Plans | $846 | 792% |
Consumer Guidance & Cost Commentary
For the CPT code 76536 (Ultrasound, thyroid and neck) at Girard Medical Center in Girard, KS, the facility's cash median price is $535.00, while the median amount paid by insurance is $312.00. This service is provided by a Critical Access Hospital, a facility type often associated with streamlined billing practices. Patients with high-deductible plans may find that paying the cash price of $535.00 directly is more cost-effective than using insurance, as the negotiated rate of $312.00 represents the maximum amount an insurer will pay, and any remaining balance could be subject to balance billing if the patient is out-of-network. It is important to note that while the facility is a Critical Access Hospital, patients should still verify their specific plan's coverage details before scheduling to avoid unexpected costs.
The facility's pricing is benchmarked against Medicare, which sets a fixed reimbursement rate of $106.81 for this procedure. The cash price of $535.00 is significantly higher than the Medicare rate, reflecting the administrative costs and profit margins inherent in commercial billing. However, the median negotiated rate of $312.00 is lower than the cash price, demonstrating the value of having insurance coverage. To minimize costs, patients should inquire about "self-pay" or "prompt-pay" discounts before check-in, as these can reduce the final bill by 20% to 50%. Additionally, if a balance bill arises, patients should request an itemized audit to identify errors or unbundled codes, as over 80% of hospital bills contain discrepancies that can be corrected