CT scan, sinuses
Facility: Decatur Health
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $852
- Cash Discount Price: $1,005
- vs. Medicare Baseline: 7.98x 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 798% of the Medicare baseline (a markup of 698%). 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 | $589 | 551% |
| Wppa/Providrs Care- All Plans | $670 | 627% |
| UnitedHealthcare | $681 - $852 | 638% |
| Humana | $688 | 644% |
| Aetna | $1,005 - $1,116 | 941% |
| Midlands Choice- All Plans | $1,005 | 941% |
| Medicaid / KanCare | $1,128 | 1056% |
Consumer Guidance & Cost Commentary
For a CT scan of the sinuses at Decatur Health in Oberlin, Kansas, the cash price is $1,005, which is lower than the facility's negotiated rates for most major insurers. While commercial payers like UnitedHealthcare and Aetna have negotiated ceilings ranging from $681 to $1,128, paying cash directly can sometimes be more cost-effective for patients with high-deductible plans, as the cash price often falls below the insurer's allowed amount. It is important to note that the cash price of $1,005 is significantly higher than the Medicare benchmark of $106.81, reflecting the standard markup in commercial healthcare pricing. Additionally, the median amount paid by patients across all plans is $770, suggesting that some patients may have received discounts or lower negotiated rates depending on their specific plan and provider network status.
To ensure you are receiving the best possible rate, we recommend requesting an itemized bill before finalizing payment, as summary bills often obscure individual charges and potential errors. If you choose to pay out-of-pocket, ask the billing department about "prompt-pay" discounts, which can reduce the total cost by 20% to 50% if settled within 30 days. Furthermore, since the facility is a Critical Access Hospital, you should verify whether your specific insurance plan has a contract with them, as in-network rates can vary widely even within the same facility. Always check your deductible status before scheduling, as using insurance without meeting your deductible could result in paying the full negotiated rate rather than a lower allowed amount.