CT scan, sinuses
Facility: St Luke Hospital & Living Center
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $795
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 7.44x 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 744% of the Medicare baseline (a markup of 644%). 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 |
|---|---|---|
| UnitedHealthcare | $795 | 744% |
| Kansas Department Of Health And Environment | $795 | 744% |
| Va Ccn | $795 | 744% |
| Blue Cross Blue Shield | $795 | 744% |
| Bluestem Pace | $795 | 744% |
| Humana | $795 | 744% |
| Ambetter / Centene | $803 | 752% |
Consumer Guidance & Cost Commentary
For the CPT code 70486 (CT scan, sinuses) at St Luke Hospital & Living Center in Marion, KS, the facility's negotiated rates for seven payers range from $795 to $803, with a median negotiated amount of $795. This rate is significantly higher than the Medicare benchmark of $106.81, reflecting the standard administrative markup inherent in commercial insurance contracts. While the facility is a Critical Access Hospital owned by a Government Hospital District, patients should be aware that cash-pay options are not listed in this report. However, for individuals with high-deductible plans where the insurance deductible has not yet been met, paying the cash price directly could result in lower out-of-pocket costs if the facility offers a self-pay discount that falls below the $795–$803 insurance allowed amount.
It is important to verify the specific "self-pay" or "prompt-pay" rates with the hospital before scheduling, as these discounts can bypass the standard insurance negotiated ceiling. Patients should request a waiver of insurance submission to ensure the billing system does not automatically process a claim that would void any upfront cash discount. Additionally, since over 80% of hospital bills often contain errors, consumers are encouraged to request a full itemized CPT-coded bill rather than accepting a summary invoice. If a balance bill arises from out-of-network ancillary services, the No Surprises Act provides federal protections that may allow patients to dispute the charges with their insurer or request an audit.