CT scan, sinuses
Facility: Hiawatha Community Hospital
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $1,032
- Cash Discount Price: $1,325
- vs. Medicare Baseline: 9.66x 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 966% of the Medicare baseline (a markup of 866%). 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 | $456 - $480 | 427% |
| UnitedHealthcare | $490 - $1,138 | 459% |
| Aetna | $490 - $1,071 | 459% |
| Humana | $495 | 463% |
| Ambetter / Centene | $588 | 551% |
| Oscar - All Plans | $994 | 931% |
| Centrus Health Direct - All Plans | $994 | 931% |
| Preferred Hlth - All Plans | $1,192 | 1116% |
| Cigna | $1,259 | 1179% |
| Wppa Providrs Care - All Plans | $1,259 | 1179% |
| Multiplan - All Plans | $1,285 | 1203% |
| Midlands Choice - All Plans | $1,285 | 1203% |
| Healthy Blue Mcaid - All Plans | $1,325 | 1241% |
Consumer Guidance & Cost Commentary
For the CT scan of the sinuses (CPT 70486) at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $1,325.00, which matches the facility's gross charge. This cash rate is significantly higher than the state average for this service, as indicated by the 9.7% variance compared to Medicare benchmarks. While commercial insurance plans like Blue Cross Blue Shield and UnitedHealthcare have negotiated rates ranging from $456 to $1,138, these amounts often exceed the cash price for patients with high-deductible plans. In such cases, paying cash upfront can be more cost-effective than relying on insurance, provided the patient understands that commercial negotiated rates frequently include administrative overhead that inflates the baseline price beyond the true cost of care.
Patients should verify whether the facility offers "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. It is important to note that even though the hospital is in-network for many payers, the actual amount paid by the insurer may not reflect the lowest possible price, and balance billing could still occur if ancillary services are out-of-network. To ensure accuracy, consumers should request a full itemized billing audit rather than accepting a summary bill, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. By comparing the facility's rates directly to Medicare benchmarks and seeking written confirmation of any discounts, patients can avoid unexpected costs and make informed financial decisions regarding their healthcare.