CT scan, sinuses
Facility: Great Plains Of Sabetha
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $630
- Cash Discount Price: $663
- vs. Medicare Baseline: 5.90x 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 590% of the Medicare baseline (a markup of 490%). 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 |
|---|---|---|
| Celtic Mcr Adv | $345 | 323% |
| Aetna | $348 - $670 | 326% |
| Celtic Comm Exchange-All Other Plans | $431 | 404% |
| Great West Healthcare-All Plans | $564 | 528% |
| UnitedHealthcare | $617 - $663 | 578% |
| Multiplan-Phcs-All Plans | $630 | 590% |
| Cigna | $630 | 590% |
| Century/Wppa/Providers-All Plans | $630 | 590% |
| Humana | $630 | 590% |
| Federated Mutual Ins-All Plans | $636 | 595% |
| Blue Cross Blue Shield | $663 | 621% |
| Medicaid / KanCare | $663 | 621% |
Consumer Guidance & Cost Commentary
For the CT scan of the sinuses at Great Plains of Sabetha, the cash price is $663.00, which matches the facility's gross charge and the cash median. This rate is significantly higher than the state average, as indicated by the 5.9% variance against Medicare benchmarks, suggesting that commercial negotiated rates in this area often exceed the true cost of care. While the facility offers a cash price equal to its gross charge, patients with high-deductible plans or those without insurance may find this direct payment option more cost-effective than using insurance, which could result in higher out-of-pocket costs if the negotiated allowed amount exceeds the cash price. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront incentives can reduce the final bill by 20% to 50%.
Insurance data shows that while some payers like Celtic Mcr Adv and Celtic Comm Exchange have a single plan paying $345 and $431 respectively, most major carriers including Aetna, UnitedHealthcare, and Blue Cross Blue Shield have negotiated rates ranging from $564 to $663. The median negotiated rate across all payers is $630.00, which remains higher than the cash price, illustrating that administrative overhead and contract structures often inflate commercial rates. Patients should be aware that balance billing is generally prohibited for emergency services under the No Surprises Act, but it is crucial to request an itemized bill to verify that no unbundled codes or services not rendered are included. If discrepancies are found, a formal written audit dispute should be sent to the billing supervisor to ensure the final invoice reflects