CT scan, sinuses
Facility: Nemaha Valley Community Hospital
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $869
- Cash Discount Price: $1,558
- vs. Medicare Baseline: 8.14x 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 814% of the Medicare baseline (a markup of 714%). 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 | $480 | 449% |
| Va Ccn - All Plans | $762 | 713% |
| Humana | $762 | 713% |
| Aetna | $769 - $1,471 | 720% |
| Celtic Comm Exch - All Plans | $838 | 785% |
| Partners Direct Health - All Plans | $900 | 843% |
| Multiplan - All Plans | $1,558 | 1459% |
| Health Partners - All Plans | $1,644 | 1539% |
| Midlands Choice - All Plans | $1,644 | 1539% |
Consumer Guidance & Cost Commentary
For a CT scan of the sinuses at Nemaha Valley Community Hospital in Seneca, Kansas, the cash price is $1,558, which matches the facility's median negotiated rate and is significantly higher than the state average of $900. While commercial insurance plans like Blue Cross Blue Shield and Va Ccn - All Plans pay a fixed $480 and $762 respectively, other payers such as Aetna and Multiplan have negotiated ranges that can reach up to $1,471 and $1,558. Because the cash price is already at the high end of the negotiated spectrum for some insurers, patients with high-deductible plans may find that paying out-of-pocket avoids the administrative fees and potential balance billing associated with insurance claims. It is advisable to confirm with the hospital whether a "self-pay" or "prompt-pay" discount is available before scheduling, as these upfront incentives can reduce the total cost.
The facility's pricing is benchmarked against Medicare, which sets a baseline rate of $106.81 for this procedure. The commercial negotiated rates are substantially higher than this federal standard, reflecting the complex administrative structures and contract dynamics between insurers and providers. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is still important to request a detailed, itemized bill to ensure no unbundled charges or services not rendered are included. If a patient receives a summary bill, they should demand a full line-by-line statement to identify any errors, as over 80% of hospital bills contain mistakes that can be corrected through a formal written audit dispute.