Ultrasound, thyroid and neck
Facility: Nmc Health
Billing Code: 76536 (CPT)
- CPT Billing Code: 76536
- Insurance Median: $171
- Cash Discount Price: $336
- vs. Medicare Baseline: 1.60x 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.
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 |
|---|---|---|
| Bluestem Pace | $97 - $101 | 91% |
| Wppa | $121 - $406 | 113% |
| Occunet | $132 - $443 | 124% |
| Medincrease Health Plan | $143 - $480 | 134% |
| Samaritan Ministries International | $143 - $480 | 134% |
| Medicaid / KanCare | $156 - $162 | 146% |
| Leading Age | $156 - $162 | 146% |
| Prime Health Services | $165 - $554 | 154% |
| Aetna | $171 - $181 | 160% |
| UnitedHealthcare | $198 - $664 | 185% |
| Cigna | $209 - $701 | 196% |
| Blue Cross Blue Shield | $481 | 450% |
Consumer Guidance & Cost Commentary
For the ultrasound procedure of the thyroid and neck at Nmc Health in Newton, KS, the facility's cash price of $336.00 is significantly lower than the average commercial negotiated rates, which range from $97 to $701 depending on the insurance carrier. While Medicare sets a benchmark rate of $106.81 for this service, commercial plans often pay between 1.6 times the Medicare amount and up to 6.6 times that figure. For patients with high-deductible plans, paying the cash price directly can be more cost-effective than relying on insurance, as the negotiated rates for many payers exceed the cash amount. It is important to note that the facility offers a voluntary non-profit structure, and patients should explicitly ask about self-pay or prompt-pay discounts before scheduling to ensure they are not billed the full negotiated rate.
The facility's pricing reflects standard commercial dynamics where administrative overhead and contract structures often inflate the baseline price beyond the true cost of care. Although the data does not provide a specific state or county average for this procedure, the wide variance in allowed amounts across different insurers highlights the importance of verifying your specific plan's allowed amount before treatment. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, unexpected charges can still occur if ancillary services are not covered under the same contract. To avoid surprises, consumers should request an itemized billing audit if they receive a large bill, ensuring that all charges are accurate and that no services were rendered but billed.