CT scan, sinuses
Facility: Clara Barton Hospital
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $1,232
- Cash Discount Price: $958
- vs. Medicare Baseline: 11.53x 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 1153% of the Medicare baseline (a markup of 1053%). 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% |
| 6 Degrees Health - All Plans | $958 | 897% |
| Wppa-All Plans | $1,095 | 1025% |
| Phcs - All Plans | $1,232 | 1153% |
| Aetna | $1,232 | 1153% |
| UnitedHealthcare | $1,232 | 1153% |
| Hlth Partners Of Ks-All Plans | $1,259 | 1179% |
Consumer Guidance & Cost Commentary
For a CT scan of the sinuses at Clara Barton Hospital in Hoisington, KS, the cash price is $958, which is lower than the facility's negotiated rate of $1,232 paid by most insurance plans. While the hospital's cash rate is higher than the state average for this procedure, it remains below the gross chargemaster price of $1,369. Patients with high-deductible plans may find paying the cash price directly more cost-effective than using insurance, as the negotiated rate often exceeds the cash amount. To secure the lowest possible price, patients should explicitly ask the billing department about self-pay discounts or prompt-pay incentives before scheduling, as these upfront fee reductions can significantly lower the final cost.
The facility's commercial negotiated rates are 11.5% higher than the Medicare benchmark for this service, reflecting the typical markup found in commercial contracts. Medicare serves as the objective baseline for pricing, and while commercial rates often range from 200% to 300% of Medicare, fair pricing is generally considered to be between 120% and 150%. It is important to note that the hospital's gross charges are inflated to make discounts appear larger; therefore, comparing rates to the Medicare amount rather than the chargemaster list provides a more accurate view of the true cost. Additionally, patients should avoid accepting summary bills that obscure individual line items, as requesting a full itemized audit is the most effective way to identify errors, unbundled codes, or services not rendered that could otherwise reduce the total debt.