CT scan, sinuses
Facility: Hospital District #6 Patterson Health Center
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $855
- Cash Discount Price: $760
- vs. Medicare Baseline: 8.00x 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 800% of the Medicare baseline (a markup of 700%). 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 | $430 - $453 | 403% |
| UnitedHealthcare | $855 - $950 | 800% |
| Providers Care (Wppa)-All Plans | $1,662 | 1556% |
Consumer Guidance & Cost Commentary
For the CPT code 70486 (CT scan, sinuses) at Hospital District #6 Patterson Health Center in Anthony, KS, the facility's cash median price of $760.00 is notably lower than the median negotiated rate of $855.00 paid by UnitedHealthcare. While the gross charge listed is $950.00, patients should be aware that commercial insurance contracts often result in higher out-of-pocket costs due to administrative overhead and contract structures. In this specific case, the cash price is approximately 90% of the UnitedHealthcare negotiated rate, suggesting that paying out-of-pocket might be more cost-effective if your insurance deductible has not yet been met or if your plan has a high deductible.
When evaluating the true cost of this service, it is essential to compare rates against the Medicare benchmark rather than the hospital's inflated chargemaster. The Medicare amount for this procedure is $106.81, which serves as the objective baseline for fair pricing; commercial negotiated rates typically range from 200% to 300% of this figure, whereas fair pricing is generally considered to be between 120% and 150%. Given that the facility is a Critical Access Hospital owned by the Government - Hospital District or Authority, patients should proactively inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing insurance billing cycles and associated administrative fees.