Ultrasound, thyroid and neck
Facility: Ellsworth County Medical Center
Billing Code: 76536 (CPT)
- CPT Billing Code: 76536
- Insurance Median: $545
- Cash Discount Price: $606
- vs. Medicare Baseline: 5.10x 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 510% of the Medicare baseline (a markup of 410%). 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 |
|---|---|---|
| Healthy Blue Mcr Adv | $285 | 267% |
| Va Ccn-All Plans | $285 | 267% |
| Humana | $285 - $576 | 267% |
| Triwest -All Plans | $285 | 267% |
| UnitedHealthcare | $394 - $606 | 369% |
| Blue Cross Blue Shield | $452 - $476 | 423% |
| First Health - All Plans | $545 | 510% |
| Aetna | $545 | 510% |
| Cigna | $576 | 539% |
| Healthy Blue Mcaid- All Other Plans | $606 | 567% |
| Coventry Mcaid-All Plans | $606 | 567% |
| Medicaid / KanCare | $606 | 567% |
| Providers Care-Wppa-All Plans | $909 | 851% |
Consumer Guidance & Cost Commentary
For the CPT code 76536 (Ultrasound, thyroid and neck) at Ellsworth County Medical Center in Ellsworth, KS, the cash price is $606.00, which matches the facility's gross charge and the cash median. This rate is significantly higher than the state average, as the cash price exceeds the typical negotiated range found across Kansas facilities. While the facility is a Critical Access Hospital with a proprietary ownership structure, patients with high-deductible plans may find that paying the cash price upfront is more cost-effective than using insurance, as the negotiated rates for in-network payers like Humana and UnitedHealthcare range from $285 to $606, often including administrative fees that inflate the final cost.
To minimize out-of-pocket expenses, patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can reduce the $606.00 cash price by 20% to 50%. It is important to note that balance billing is generally prohibited for emergency services under the No Surprises Act, though patients should verify their specific plan's network status to avoid unexpected charges. Additionally, since the Medicare benchmark for this service is $106.81, the commercial rates reflect a substantial markup; however, the facility's cash rate aligns with the highest end of the payer range, suggesting that direct payment without insurance involvement offers the most predictable and potentially lower cost for the patient.