CT scan, sinuses
Facility: Girard Medical Center
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $805
- Cash Discount Price: $1,380
- vs. Medicare Baseline: 7.54x 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 754% of the Medicare baseline (a markup of 654%). 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 | $480 - $805 | 449% |
| Aetna | $805 - $4,025 | 754% |
| Humana | $805 | 754% |
| Ambetter / Centene | $805 | 754% |
| Medicare (plans) | $805 | 754% |
| UnitedHealthcare | $805 - $2,185 | 754% |
| Kansas Superior Select-All Plans | $805 | 754% |
| Multiplan-All Plans | $2,128 | 1992% |
| Uhhis-All Plans | $2,185 | 2046% |
Consumer Guidance & Cost Commentary
For a CT scan of the sinuses at Girard Medical Center in Girard, KS, the facility's cash median price is $1,380, while the negotiated rate paid by most insurance plans is $805. This specific procedure is billed under CPT code 70486, and the facility, a Critical Access Hospital owned by a government hospital district, has a facility rating of 2. While the cash price is higher than the negotiated rate, patients with high-deductible plans may find that paying cash directly is more cost-effective if their insurance allows a negotiated rate that exceeds the cash price. It is important to note that commercial negotiated rates often include administrative overhead and can be significantly higher than the true cost of care, which is better represented by the Medicare benchmark of $106.81 for this service.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, unexpected charges can still occur if ancillary services are billed separately. To avoid confusion, consumers should request a full itemized bill before paying, as summary invoices may hide unbundled codes or services not rendered. Additionally, many facilities offer prompt-pay discounts for upfront payment, which can reduce the total cost by 20% to 50%, so it is advisable to ask about self-pay or prompt-pay rates before scheduling. Given that over 80% of hospital bills contain errors, disputing any discrepancies in writing with the billing supervisor is the most effective way to ensure accuracy and reduce potential medical debt.