Ultrasound, thyroid and neck
Facility: Hiawatha Community Hospital
Billing Code: 76536 (CPT)
- CPT Billing Code: 76536
- Insurance Median: $761
- Cash Discount Price: $977
- vs. Medicare Baseline: 7.12x 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 712% of the Medicare baseline (a markup of 612%). 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 | $361 - $839 | 338% |
| Aetna | $361 - $789 | 338% |
| Humana | $365 | 342% |
| Ambetter / Centene | $434 | 406% |
| Blue Cross Blue Shield | $457 - $481 | 428% |
| Centrus Health Direct - All Plans | $733 | 686% |
| Oscar - All Plans | $733 | 686% |
| Preferred Hlth - All Plans | $879 | 823% |
| Cigna | $928 | 869% |
| Wppa Providrs Care - All Plans | $928 | 869% |
| Multiplan - All Plans | $948 | 888% |
| Midlands Choice - All Plans | $948 | 888% |
| Healthy Blue Mcaid - All Plans | $977 | 915% |
Consumer Guidance & Cost Commentary
For the ultrasound of the thyroid and neck at Hiawatha Community Hospital, the cash price is $977.00, which matches the facility's median negotiated rate. This cash price is significantly lower than the state average for this procedure, as the median paid amount across all payers is $733.00, indicating that commercial insurance contracts often result in higher net costs for patients compared to direct cash payment. While the facility is a Critical Access Hospital in Hiawatha, KS, with a facility rating of 3, patients should be aware that paying cash upfront may be the most cost-effective option, particularly if their insurance deductible has not yet been met or if their plan's negotiated rate exceeds the cash price. It is advisable to explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as hospitals often offer fee reductions of 20% to 50% for upfront payment to bypass administrative claim processing costs.
The Medicare benchmark for this service is $106.81, which serves as a baseline for evaluating the facility's pricing markup. The facility's cash rate of $977.00 represents a substantial increase over the Medicare amount, reflecting the complexity of the procedure and the facility's operational costs. However, when compared to the broader market, the cash price remains competitive relative to the high end of commercial payer ranges, where some plans like Cigna and Multiplan have negotiated rates of $928.00 and $948.00 respectively. To ensure you are not overcharged, patients should request a detailed, itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbund