CT scan, sinuses
Facility: Republic County Hospital
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $1,104
- Cash Discount Price: $900
- vs. Medicare Baseline: 10.34x 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 1034% of the Medicare baseline (a markup of 934%). 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 |
|---|---|---|
| Rural Carriers-All Plans | $1,020 | 955% |
| Meritain-All Plans | $1,080 | 1011% |
| Aetna | $1,080 | 1011% |
| UnitedHealthcare | $1,104 | 1034% |
| Midlands Choice-All Plans | $1,140 | 1067% |
| First Health-All Plans | $1,140 | 1067% |
| Cigna | $1,140 | 1067% |
Consumer Guidance & Cost Commentary
For a CT scan of the sinuses at Republic County Hospital in Belleville, KS, the negotiated rates for in-network payers range from $1,020 to $1,140, while the cash price is $900. This cash rate is notably lower than the facility's median negotiated payment of $1,080 and the median negotiated rate of $1,104 across all plans. Because the cash price is lower than the insurance negotiated rates, patients with high-deductible plans may save money by paying out-of-pocket upfront, provided they qualify for the facility's self-pay or prompt-pay discounts. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still verify their specific plan details and request a waiver of insurance submission before scheduling to ensure they are not inadvertently enrolled in a billing cycle that could void cash discounts.
The facility's pricing structure is evaluated against federal benchmarks, with the Medicare amount for this service set at $106.81. Commercial negotiated rates often exceed Medicare benchmarks due to administrative costs and contract dynamics, though fair pricing is typically defined as 120% to 150% of the Medicare rate. In this case, the cash price of $900 represents a significant reduction compared to the standard billing practices where commercial rates can average 200% to 300% of Medicare. Patients should be aware that hospitals often issue summary bills that obscure individual charges; if you receive a bill, you have the right to request a full itemized audit to identify any errors, unbundled codes, or services not rendered, as over