CT scan, sinuses
Facility: Pratt Regional Medical Center
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $138
- Cash Discount Price: $814
- vs. Medicare Baseline: 1.29x 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 |
|---|---|---|
| Celtic Insurance Company | $102 | 95% |
| Christian Health Aid | $104 - $1,639 | 97% |
| Healthy Blue | $105 | 98% |
| UnitedHealthcare | $112 - $2,229 | 105% |
| Health Partners Of Kansas | $117 - $1,857 | 110% |
| Aetna | $124 - $1,967 | 116% |
| Choicecare | $138 - $2,185 | 129% |
Consumer Guidance & Cost Commentary
For this CT scan of the sinuses at Pratt Regional Medical Center in Pratt, Kansas, the facility's cash price of $814.00 is notably higher than the state average for this procedure. While commercial insurance plans like Celtic Insurance Company and Healthy Blue have negotiated rates starting around $102 to $105, these amounts are significantly lower than the cash price, which may be advantageous for patients with high-deductible plans who have not yet met their coverage thresholds. It is important to note that commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the baseline price by 20% to 40% compared to direct cash payments, though in this specific case, the cash rate remains the highest figure among the available options.
The facility's negotiated rates for in-network payers range from $102 to $2,185, with UnitedHealthcare and Aetna showing the widest variation across their plan portfolios. These rates are compared against a Medicare benchmark of $106.81, which serves as the federal baseline for cost; the facility's cash rate represents a markup of 1.3 times the Medicare amount. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, it is crucial to request a self-pay or prompt-pay discount before scheduling to avoid unexpected costs. Since over 80% of hospital bills contain errors, consumers are advised to request a detailed, itemized bill to verify that all charges align with the negotiated or cash rates listed here.