CT scan, sinuses
Facility: Clay County Medical Center
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $95
- Cash Discount Price: $828
- vs. Medicare Baseline: 0.89x 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.
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 |
|---|---|---|
| Multiplan- All Plans | $40 - $1,478 | 37% |
| UnitedHealthcare | $67 - $1,478 | 63% |
| Health Partners - All Plans | $75 - $1,478 | 70% |
| Aetna | $93 - $1,447 | 87% |
| Wppa/Providrs Care- All Plans | $93 - $1,447 | 87% |
Consumer Guidance & Cost Commentary
For a CT scan of the sinuses at Clay County Medical Center in Clay Center, KS, the cash median price is $828.00, which matches the facility's gross charge. This rate is significantly lower than the state average for this procedure, where commercial negotiated rates typically range from $95.00 to $1,478.00 depending on the payer. While the facility is a Critical Access Hospital owned by the local government, patients should note that cash payments can sometimes be more cost-effective than using insurance if your plan has a high deductible or if the insurer's negotiated rate exceeds the cash price. We recommend asking the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing administrative fees associated with insurance claims.
The Medicare benchmark for this service is $106.81, serving as the objective baseline for evaluating pricing markups. Commercial rates for this procedure often average 200% to 300% of the Medicare amount, whereas fair pricing is typically defined as 120% to 150% of the Medicare rate. In this case, the median negotiated amount across payers is $95.00, which is higher than the cash price but still below the maximum high-end rates seen in other payers like UnitedHealthcare or Health Partners. To ensure you are receiving the best possible rate, verify your specific plan's allowed amount before scheduling, as in-network rates can vary significantly between carriers. Additionally, if you receive an itemized bill, request a full line-by-line audit to identify any errors, unbundled codes, or services not rendered, as over 8