CT scan, sinuses
Facility: Ashland Health Center
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $667
- Cash Discount Price: $534
- vs. Medicare Baseline: 6.24x 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 624% of the Medicare baseline (a markup of 524%). 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 | $223 | 209% |
| Compalliance-All Plans | $534 | 500% |
| Health Partners Of Kansas-All Plans | $567 | 531% |
| Multiplan-All Plans | $654 | 612% |
| Medica Mcare - All Plans | $667 | 624% |
| Healthy Blue Mcr Adv - All Other Plans | $667 | 624% |
| Aetna | $667 | 624% |
| Medicare (plans) | $667 | 624% |
| UnitedHealthcare | $667 | 624% |
| Medicaid / KanCare | $667 | 624% |
| Health Choice-All Plans | $667 | 624% |
| Providers Care (Wppa)-All Plans | $1,000 | 936% |
Consumer Guidance & Cost Commentary
For the CPT code 70486, representing a CT scan of the sinuses at Ashland Health Center in Ashland, Kansas, the facility's cash median price is $534.00, which is lower than the facility's negotiated rate of $667.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds this amount. It is important to note that commercial payers like Blue Cross Blue Shield and Compalliance-All Plans have negotiated rates of $223 and $534 respectively, which are significantly lower than the gross charge of $667.00, yet still higher than the cash price. Patients should verify their specific plan's allowed amount before scheduling, as assuming in-network coverage guarantees the lowest possible price can lead to unexpected costs if the contract rate is higher than the self-pay rate.
The Medicare benchmark for this service is $106.81, which serves as a baseline for evaluating the facility's pricing markup. The facility's cash median of $534.00 is approximately 5 times the Medicare amount, while the negotiated rate of $667.00 is roughly 6.2 times the Medicare rate. Although the data does not provide explicit state or county average comparisons for this specific procedure, the significant difference between the cash price and the negotiated rates highlights the potential savings available through prompt-pay discounts or self-pay arrangements. To minimize medical debt, consumers should request an itemized bill to ensure no unbundled codes or services not rendered are included, and they should consider asking