CT scan, sinuses
Facility: Trego County Lemke Memorial Hospital
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $657
- Cash Discount Price: $659
- vs. Medicare Baseline: 6.15x 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 615% of the Medicare baseline (a markup of 515%). 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 |
|---|---|---|
| Humana | $380 | 356% |
| Tricare | $410 | 384% |
| Medicaid / KanCare | $480 - $775 | 449% |
| UnitedHealthcare | $480 - $775 | 449% |
| Aetna | $480 - $698 | 449% |
| Va Ccn - All Plans | $480 | 449% |
| Ambetter / Centene | $529 | 495% |
| Blue Cross Blue Shield | $657 | 615% |
| Health Partners - All Plans | $736 | 689% |
| Healthy Blue Mcaid - All Plans | $775 | 726% |
Consumer Guidance & Cost Commentary
For a CT scan of the sinuses at Trego County Lemke Memorial Hospital, the cash price is $659, which is lower than the facility's negotiated rates with most major payers. While the hospital's cash rate is competitive, it is important to note that commercial insurance plans often negotiate higher rates due to administrative costs and contract structures; for instance, UnitedHealthcare and Medicaid/KanCare have negotiated ranges extending up to $775. Patients with high-deductible plans may find paying the cash price directly more affordable than having their insurance cover the service, especially if the negotiated rate exceeds the cash amount. To maximize savings, we recommend asking the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront.
This facility is a Critical Access Hospital in Wakeeney, Kansas, with a government-local ownership structure. The Medicare benchmark for this procedure is $106.81, which serves as the objective baseline for evaluating pricing markups. Commercial rates typically range from 200% to 300% of the Medicare amount, whereas fair pricing is generally defined as 120% to 150% of the Medicare rate. Given that the cash price of $659 is significantly higher than the Medicare benchmark, patients should verify their specific plan's allowed amount before scheduling. Additionally, since over 80% of hospital bills contain errors, we strongly advise requesting an itemized bill that lists every CPT code and unit cost to identify any unbundled charges or services not rendered, ensuring you are only paying for what was actually provided.