CT scan, sinuses
Facility: Nmc Health
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $873
- Cash Discount Price: $1,063
- vs. Medicare Baseline: 8.17x 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 817% of the Medicare baseline (a markup of 717%). 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 |
|---|---|---|
| Bluestem Pace | $101 | 95% |
| Leading Age | $162 | 152% |
| Medicaid / KanCare | $162 | 152% |
| Aetna | $412 | 386% |
| Blue Cross Blue Shield | $480 | 449% |
| Wppa | $835 | 782% |
| Occunet | $911 | 853% |
| Samaritan Ministries International | $987 | 924% |
| Medincrease Health Plan | $987 | 924% |
| Prime Health Services | $1,139 | 1066% |
| UnitedHealthcare | $1,366 | 1279% |
| Cigna | $1,442 | 1350% |
Consumer Guidance & Cost Commentary
For this CT scan of the sinuses at Nmc Health in Newton, KS, the facility's cash price of $1,063 is significantly lower than the average negotiated rates charged to insurance plans, which range from $101 for Bluestem Pace to $1,442 for Cigna. While the facility's cash rate is higher than the state average for this procedure, it remains substantially below the gross chargemaster price of $1,518. Patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rates for many payers exceed the cash amount. To secure the lowest possible cost, it is advisable to ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the bill when paid in full upfront.
The data indicates that Medicare rates for this service are set at $106.81, serving as a critical benchmark to evaluate the facility's pricing markup. The facility's negotiated average of $873 is approximately 8.2 times the Medicare rate, reflecting the administrative costs and contract structures inherent in commercial insurance billing. Because over 80% of hospital bills contain errors, patients should request a detailed, itemized statement rather than accepting a summary bill, which can hide unbundled charges or services not rendered. If a balance bill arises from an out-of-network provider, such as an emergency physician or lab, the No Surprises Act may protect you from paying the difference, so it is important to dispute any unexpected charges in writing rather than paying immediately out of fear.