CT scan, sinuses
Facility: Wilson Medical Center
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $701
- Cash Discount Price: $657
- vs. Medicare Baseline: 6.56x 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 656% of the Medicare baseline (a markup of 556%). 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 - $876 | 424% |
| Tricare | $464 | 434% |
| Humana | $464 | 434% |
| Ambetter / Centene | $464 - $876 | 434% |
| UnitedHealthcare | $464 - $815 | 434% |
| Aetna | $464 - $876 | 434% |
| Cigna | $701 | 656% |
| Mulitplan-All Plans | $806 | 755% |
| Health Partners-All Plans | $806 | 755% |
Consumer Guidance & Cost Commentary
For the CT scan of the sinuses at Wilson Medical Center in Neodesha, KS, the facility's cash median price is $657.00, which is lower than the state average of $701.00. While several major payers like Blue Cross Blue Shield and Aetna have negotiated rates ranging up to $876.00, the cash price may be more cost-effective for patients with high-deductible plans who have not yet met their coverage thresholds. Because commercial negotiated rates often include administrative overhead and contract markups, paying out-of-pocket directly can sometimes result in a lower total cost than what insurance allows, provided the patient qualifies for the facility's self-pay or prompt-pay discounts.
The facility's billing practices align with federal protections against surprise balance billing, particularly under the No Surprises Act, which prevents unexpected charges for out-of-network services at in-network facilities. Patients should be aware that while the facility is a Critical Access Hospital with government local ownership, they must request a full itemized bill to verify all charges and avoid paying for services that were not rendered or codes that were incorrectly unbundled. If a patient receives a bill exceeding the cash median, they should dispute any discrepancies in writing and confirm whether the facility applied the correct prompt-pay discount before scheduling future care.