CT scan, sinuses
Facility: Holton Community Hospital
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $978
- Cash Discount Price: $884
- vs. Medicare Baseline: 9.16x 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 916% of the Medicare baseline (a markup of 816%). 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 | $453 | 424% |
| UnitedHealthcare | $624 - $1,178 | 584% |
| Aetna | $624 - $1,178 | 584% |
| Humana | $631 | 591% |
| Kansas Superior Select - All Plans | $637 | 596% |
| Preferred Health Professionals | $978 | 916% |
| Preferred Health Fn Select - All Other Plans | $978 | 916% |
| Preferred Health Freedom | $978 | 916% |
| Wppa Providers - All Plans | $1,119 | 1048% |
| Medicaid / KanCare | $1,178 | 1103% |
Consumer Guidance & Cost Commentary
For a CT scan of the sinuses at Holton Community Hospital in Holton, Kansas, the cash median price is $884, which is lower than the facility's gross charge of $1,178. While this cash rate is competitive, it is important to note that insurance negotiated rates for this service vary significantly by plan; for example, UnitedHealthcare and Aetna have negotiated rates ranging from $624 to $1,178 depending on the specific plan. Because commercial negotiated rates often include administrative overhead and can sometimes exceed cash prices, patients with high-deductible plans may find paying the cash median of $884 directly to the hospital more cost-effective than relying on insurance, provided they have not yet met their deductible.
The facility's pricing is benchmarked against Medicare, which sets a fixed reimbursement rate of $106.81 for this procedure. The cash price of $884 represents a markup of 9.2 times the Medicare rate, which is consistent with typical commercial pricing structures where negotiated rates average 200% to 300% of Medicare. To ensure you receive the best possible price, we recommend asking the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill. Additionally, if you receive an itemized bill, request a full line-by-line audit to verify that all charges correspond to services actually rendered, as over 80% of hospital bills contain errors that can be corrected.