CT scan, sinuses
Facility: Grisell Memorial Hospital
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $816
- Cash Discount Price: $889
- vs. Medicare Baseline: 7.64x 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 764% of the Medicare baseline (a markup of 664%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $430 | 403% |
| UnitedHealthcare | $696 - $936 | 652% |
| Medicaid / KanCare | $936 | 876% |
| Humana | $936 | 876% |
Consumer Guidance & Cost Commentary
For the CPT code 70486 (CT scan, sinuses) at Grisell Memorial Hospital in Ransom, Kansas, the facility's cash median price is $889.00, which is slightly lower than the total gross charge of $936.00. While the hospital is a Critical Access Hospital owned by a Government Hospital District, the negotiated rates for in-network payers like UnitedHealthcare range from $696 to $936, meaning the cash price is often the most economical option for patients with high-deductible plans or those without insurance. It is important to note that commercial negotiated rates frequently exceed cash prices due to administrative overhead and contract structures, so patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not paying the full insurance allowed amount.
The Medicare benchmark for this service is $106.81, which serves as a critical baseline for evaluating the facility's pricing markup. The facility's cash rate of $889.00 represents a significant markup compared to the federal government's calculated cost basis, a common practice in the healthcare industry where commercial rates can average 200% to 300% of Medicare amounts. If you have received a bill from this facility, you should request a detailed, itemized statement to verify that all charges are accurate and that no services were unbundled or double-billed, as over 80% of hospital bills contain errors. Additionally, if you are an out-of-network patient, you may be subject to balance billing for the difference between the provider's charge and your insurance payment, though the No Surprises Act