Ultrasound, thyroid and neck
Facility: William Newton Hospital
Billing Code: 76536 (CPT)
- CPT Billing Code: 76536
- Insurance Median: $177
- Cash Discount Price: $364
- vs. Medicare Baseline: 1.66x 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 |
|---|---|---|
| Triwest- All Plans | $127 | 119% |
| UnitedHealthcare | $131 - $328 | 123% |
| Ambetter / Centene | $131 - $364 | 123% |
| Blue Cross Blue Shield | $131 - $457 | 123% |
| Providrs Care Nexus | $223 | 209% |
| Providrs Care - All Other Plans | $255 | 239% |
Consumer Guidance & Cost Commentary
For the CPT code 76536, "Ultrasound, thyroid and neck," William Newton Hospital in Winfield, KS, lists a cash price of $364.00, which matches the facility's median negotiated rate. This cash price is significantly higher than the state of Kansas average, which is approximately 170% of the Medicare benchmark of $106.81. While commercial payers like UnitedHealthcare and Blue Cross Blue Shield have negotiated rates ranging from $131 to $457, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that the facility is a Critical Access Hospital with government local ownership, and patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling to ensure they are not being charged the full negotiated amount.
The data indicates that the median amount paid by insurance carriers is $131.00, which is roughly 36% of the cash price, suggesting that for many insured patients, the out-of-pocket cost after deductibles could be substantial if their plan does not cover the full negotiated rate. However, patients should be cautious of balance billing if they are out-of-network, as the No Surprises Act protects against surprise bills for emergency care and non-emergency services at in-network facilities. To avoid unexpected costs, consumers should request an itemized bill to review specific CPT codes and unit charges, ensuring no unbundled fees or services not rendered are included. Always confirm your deductible status and ask the billing department to classify your visit as self-pay if you intend to pay the cash rate directly,