CT scan, sinuses
Facility: Kiowa District Hospital
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $821
- Cash Discount Price: $705
- vs. Medicare Baseline: 7.69x 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 769% of the Medicare baseline (a markup of 669%). 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 |
|---|---|---|
| Healthchoice-All Plans | $280 | 262% |
| Tricare | $337 - $350 | 316% |
| Blue Cross Blue Shield | $453 | 424% |
| UnitedHealthcare | $691 - $898 | 647% |
| Health Partners Of Ks-All Plans | $760 - $790 | 712% |
| Humana | $780 - $810 | 730% |
| Gbs Insurance - All Plans | $812 - $844 | 760% |
| Multiplan-All Plans | $812 - $844 | 760% |
| Triwest-All Plans | $821 - $853 | 769% |
| Aetna | $821 - $853 | 769% |
| Medicare (plans) | $821 - $853 | 769% |
| Medicaid / KanCare | $864 - $898 | 809% |
| Providers Care (Wppa)-All Plans | $1,296 - $1,347 | 1213% |
| Liberty Healthshare-All Plans | $1,395 - $1,450 | 1306% |
Consumer Guidance & Cost Commentary
For the CPT code 70486 (CT scan, sinuses), the gross charge at Kiowa District Hospital in Kiowa, KS is $881.00. While the facility's cash median rate is $705.00, which is lower than the gross charge, the negotiated rates for in-network payers vary significantly, ranging from $280 for Healthchoice-All Plans to $1,450 for Liberty Healthshare-All Plans. It is important to note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures; therefore, patients with high-deductible plans may find paying the cash median of $705.00 upfront more cost-effective than relying on insurance, which could result in a higher allowed amount. Additionally, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts, which can further reduce the final out-of-pocket cost.
When evaluating the true cost of this service, it is essential to compare rates against the Medicare benchmark rather than the hospital's gross charge. The Medicare amount for this procedure is $106.81, which serves as the scientifically validated baseline for fair pricing. Commercial negotiated rates typically average between 200% and 300% of the Medicare rate, whereas fair pricing is generally defined as 120% to 150% of this benchmark. For instance, the lowest negotiated rate of $280 is approximately 2.6 times the Medicare amount, while the highest rate of $1,450 exceeds 13.5 times the Medicare amount. Patients should request an itemized billing audit to ensure no errors