Ultrasound, thyroid and neck
Facility: Regional Medical Center
Billing Code: 76536 (CPT)
- CPT Billing Code: 76536
- Insurance Median: $870
- Cash Discount Price: $450
- vs. Medicare Baseline: 8.15x 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 815% of the Medicare baseline (a markup of 715%). 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 |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 815% |
Consumer Guidance & Cost Commentary
If you are paying out-of-pocket for this ultrasound, the most important thing to know upfront is that the cash median rate of $450 may be lower than your insurance negotiated rate, which is $870. Because commercial insurance contracts often include administrative overhead and markup, the cash price can sometimes be the most affordable option for patients with high-deductible plans or those who have not yet met their deductible. Before scheduling, you should explicitly ask the hospital to classify your visit as self-pay and inquire about any prompt-pay discounts, which can reduce the bill by 20% to 50% if paid in full within a short window.
This facility's cash rate of $450 is significantly lower than the state average for this procedure, which is $563, making it a cost-effective choice for self-pay patients in the region. However, while the cash price is competitive, be aware that the median negotiated rate of $870 is higher than the cash amount, confirming that paying directly can save money in this specific case. Always verify your specific plan's allowed amount before proceeding, as the difference between the cash rate and your insurance allowed amount could result in balance billing if you do not secure a self-pay discount or waive insurance submission prior to your appointment.