CT scan, sinuses
Facility: Medicine Lodge Memorial Hospital
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $601
- Cash Discount Price: $633
- vs. Medicare Baseline: 5.63x 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 563% of the Medicare baseline (a markup of 463%). 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 |
|---|---|---|
| Tricare | $507 | 475% |
| Humana | $576 | 539% |
| Aetna | $585 - $633 | 548% |
| UnitedHealthcare | $601 | 563% |
| Hpk-All Plans | $601 | 563% |
| Medicaid / KanCare | $633 | 593% |
Consumer Guidance & Cost Commentary
For a CT scan of the sinuses at Medicine Lodge Memorial Hospital, the cash price is $633, which matches the highest negotiated rate paid by Aetna and the gross charge. While the facility is a Critical Access Hospital in Kansas, the data provided does not include specific state or county average benchmarks for comparison. It is important to note that for patients with high-deductible plans, paying the cash price of $633 upfront can sometimes be more cost-effective than relying on insurance, as commercial negotiated rates often exceed the cash price due to administrative overhead and contract structures. Patients should verify their specific plan details and ask the hospital directly about any "self-pay" or "prompt-pay" discounts that may reduce the final bill.
The Medicare benchmark for this procedure is $106.81, which serves as the objective baseline for evaluating pricing markups. Commercial rates, including the cash price of $633, represent a significant markup relative to this federal standard, reflecting the complex administrative costs and network dynamics inherent in commercial insurance. If you have insurance, the allowed amount is $601, but this does not guarantee the lowest possible price, as in-network rates vary by carrier and contract. To ensure you are not overcharged, request a full itemized bill to review every line item for accuracy and confirm that no unexpected balance billing is occurring, especially if you are concerned about out-of-network ancillary services.