CT scan, sinuses
Facility: Susan B Allen Memorial Hospital
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $635
- Cash Discount Price: $741
- vs. Medicare Baseline: 5.95x 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 595% of the Medicare baseline (a markup of 495%). 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 | $350 | 328% |
| Providrs Care | $919 | 860% |
Consumer Guidance & Cost Commentary
For a CT scan of the sinuses at Susan B Allen Memorial Hospital in El Dorado, KS, the facility's cash median price is $741.00, which is notably lower than the negotiated rates paid by UnitedHealthcare ($350) and Providrs Care ($919). While commercial insurance contracts often set a ceiling on what insurers pay, these negotiated amounts can sometimes exceed the cash price, making self-pay a potentially more affordable option for patients with high-deductible plans who have not yet met their coverage thresholds. The facility's cash rate is also significantly lower than the Medicare benchmark of $106.81 for this procedure, indicating a substantial markup relative to the federal government's cost-based reimbursement standard.
Patients should be aware that while the hospital is an in-network facility for these payers, the final amount owed depends heavily on individual plan deductibles and negotiated contracts. It is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the bill by bypassing administrative claim processing fees. Additionally, since over 80% of hospital bills contain errors, consumers are encouraged to request a full itemized statement before making any payment to verify that all charges are accurate and that no services were unbundled or double-billed.