CT scan, sinuses
Facility: Kansas Medical Center Llc
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $96
- Cash Discount Price: $564
- vs. Medicare Baseline: 0.90x 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 |
|---|---|---|
| Medicaid / KanCare | $60 | 56% |
| Indian Health | $87 | 81% |
| Tricare | $87 | 81% |
| Humana | $96 | 90% |
| Ambetter / Centene | $96 | 90% |
| Medadv_Wellcare | $96 | 90% |
| Blue Cross Blue Shield | $96 - $437 | 90% |
| Three_Rivers | $193 | 181% |
| Aetna | $450 | 421% |
| Wppa | $525 | 492% |
| United | $580 | 543% |
Consumer Guidance & Cost Commentary
For a CT scan of the sinuses at Kansas Medical Center Llc in Andover, the cash price is $564, which is lower than the facility's negotiated rates for most commercial payers. While the facility's median negotiated rate is $588, commercial insurance plans like Blue Cross Blue Shield and Aetna have allowed amounts ranging from $193 to $525, meaning patients with these plans could potentially pay less than the cash price if their insurance covers the service. However, patients should be aware that insurance often includes administrative fees and may not cover the full amount, so it is crucial to verify your specific deductible status and allowed amount before scheduling. Additionally, the facility offers a prompt-pay discount for self-pay patients, which can further reduce the final bill if paid in full upfront.
When evaluating the cost, it is important to compare rates against objective benchmarks rather than the hospital's inflated chargemaster list. The Medicare benchmark for this procedure is $106.81, which serves as the scientifically validated baseline for the true cost of care. Commercial negotiated rates typically average 200% to 300% of this Medicare rate, while fair pricing is generally defined as 120% to 150%. For this specific code, the cash price of $564 represents a significant markup over the Medicare rate, but it remains the most transparent and predictable option for patients without insurance. If you are self-paying, you should request a formal itemized bill to ensure no errors or unbundled charges are included, as over 80% of hospital bills contain discrepancies that can be corrected through a written audit.