CT scan, sinuses
Facility: Lane County Hospital
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $950
- Cash Discount Price: $950
- vs. Medicare Baseline: 8.89x 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 889% of the Medicare baseline (a markup of 789%). 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 |
|---|---|---|
| Aetna | $855 - $902 | 800% |
| UnitedHealthcare | $855 - $950 | 800% |
| Healthy Blue Mcr Adv - All Other Plans | $950 | 889% |
| Medicaid / KanCare | $950 - $1,045 | 889% |
| Healthy Blue Mcaid | $950 | 889% |
| Wppa Providers-All Plans | $1,425 | 1334% |
Consumer Guidance & Cost Commentary
For the CPT code 70486 (CT scan, sinuses) at Lane County Hospital in Dighton, KS, the facility's cash price of $950 aligns exactly with the median negotiated rate and the cash median reported for this service. This facility is a Critical Access Hospital owned by a Government Hospital District, which often influences pricing structures. While the gross charge listed is $950, commercial payers such as Aetna and UnitedHealthcare have negotiated rates ranging from $855 to $950, indicating that in-network members are paying at or near the cash price. Notably, the Medicare benchmark for this procedure is significantly lower at $106.81, highlighting that the commercial rates represent a substantial markup over the federal baseline. When comparing to regional standards, the facility's cash price matches the state and county averages, meaning patients are not paying above the typical rate for this procedure in the area.
Patients should be aware that paying cash upfront may offer savings if their insurance plan's negotiated rate exceeds the cash price, though in this specific case, the rates are identical. To maximize potential discounts, it is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% for upfront payment. Since the facility is in-network, the No Surprises Act generally protects patients from balance billing for emergency or non-emergency services, but patients should still request an itemized bill to verify all charges. If you have a high-deductible plan, ensure you understand your deductible status before scheduling, as you may be responsible for the full negotiated amount until that threshold is met