Ultrasound, thyroid and neck
Facility: Wilson Medical Center
Billing Code: 76536 (CPT)
- CPT Billing Code: 76536
- Insurance Median: $762
- Cash Discount Price: $714
- vs. Medicare Baseline: 7.13x 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 713% of the Medicare baseline (a markup of 613%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $476 - $952 | 446% |
| Humana | $505 | 473% |
| Ambetter / Centene | $505 - $952 | 473% |
| UnitedHealthcare | $505 - $885 | 473% |
| Tricare | $505 | 473% |
| Aetna | $505 - $952 | 473% |
| Cigna | $762 | 713% |
| Mulitplan-All Plans | $876 | 820% |
| Health Partners-All Plans | $876 | 820% |
Consumer Guidance & Cost Commentary
For the CPT code 76536 (Ultrasound, thyroid and neck) at Wilson Medical Center in Neodesha, KS, the facility's cash median price is $714.00, which is lower than the negotiated rates paid by most major insurers. While the facility's cash rate is significantly below the gross charge of $952.00, it is important to note that commercial insurance plans often negotiate rates that exceed the cash price; for instance, Blue Cross Blue Shield and Aetna have negotiated ranges extending up to $952.00. This dynamic suggests that patients with high-deductible plans or those who have not yet met their out-of-pocket maximums might save money by paying the cash price directly, provided they can secure a "self-pay" or "prompt-pay" discount from the hospital before scheduling.
The facility's pricing is also contextualized against Medicare benchmarks, where the Medicare amount for this service is $106.81. The cash median of $714.00 represents a substantial markup over the federal baseline, illustrating that commercial rates are often significantly higher than the true cost of care as defined by Medicare. To ensure you are not overpaying, it is advisable to request an itemized billing audit if you receive a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, if you encounter a balance bill from an out-of-network provider at this in-network Critical Access Hospital, you may be entitled to protections under the No Surprises Act, which bans balance billing for emergency and non-emergency services at in-network facilities.