CT scan, sinuses
Facility: Smith County Memorial Hospital
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $660
- Cash Discount Price: $703
- vs. Medicare Baseline: 6.18x 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 618% of the Medicare baseline (a markup of 518%). 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 | $453 | 424% |
| Medicaid / KanCare | $492 - $703 | 461% |
| Multiplan-All Plans | $632 | 592% |
| Wppa-All Plans | $660 | 618% |
| UnitedHealthcare | $667 | 624% |
| Health Partners Of Ks Ppo-All Plans | $667 | 624% |
| Midlands Choice-All Plans | $667 | 624% |
Consumer Guidance & Cost Commentary
For the CT scan of the sinuses at Smith County Memorial Hospital in Smith Center, Kansas, the cash price is $703.00, which matches the facility's median negotiated rate of $660.00 and the cash median. This service is billed under CPT code 70486. While the facility is a Critical Access Hospital owned by the local government, the data indicates that the cash price is identical to the negotiated rate paid by insurers like Medicaid/KanCare and UnitedHealthcare. Patients with high-deductible plans or those without insurance may find the cash price of $703.00 to be the most cost-effective option, as it avoids the administrative overhead often associated with insurance billing cycles. It is important to note that while the cash price is listed as $703.00, patients should always verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these programs can sometimes reduce the final amount owed.
The facility's pricing structure does not show a significant deviation from the Medicare benchmark, which is set at $106.81 for this procedure. Although the commercial negotiated rate of $660.00 is substantially higher than the Medicare rate, this markup is consistent with the administrative costs and contract dynamics typical of in-network care. The data provided does not include specific comparisons to state or county average rates for this specific code, so patients should rely on the facility's published cash price and any available prompt-pay discounts to determine their out-of-pocket costs. If a patient receives a bill that exceeds the cash price or the negotiated rate, they should request an itemized billing audit to identify potential errors, such as unb