CT scan, sinuses
Facility: William Newton Hospital
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $521
- Cash Discount Price: $1,243
- vs. Medicare Baseline: 4.88x 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 488% of the Medicare baseline (a markup of 388%). 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 |
|---|---|---|
| Triwest- All Plans | $363 - $506 | 340% |
| UnitedHealthcare | $374 - $1,303 | 350% |
| Ambetter / Centene | $374 - $1,448 | 350% |
| Blue Cross Blue Shield | $374 - $521 | 350% |
| Providrs Care Nexus | $636 - $886 | 595% |
| Providrs Care - All Other Plans | $727 - $1,013 | 681% |
Consumer Guidance & Cost Commentary
For a CT scan of the sinuses at William Newton Hospital in Winfield, KS, the cash price is $1,243, which matches the facility's median paid amount. This cash rate is significantly higher than the state average for this procedure, as indicated by the 4.9x markup compared to the Medicare benchmark of $106.81. While commercial insurance plans like UnitedHealthcare and Ambetter / Centene negotiate rates ranging from $374 to $1,448, these negotiated amounts often exceed the cash price. Patients with high-deductible plans may find it financially advantageous to pay the cash rate directly, as the upfront cost is lower than what their insurance would allow, provided they have not yet met their deductible.
To maximize savings, patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling their visit, as these can reduce the bill by 20% to 50%. It is critical to avoid automatic claims submission, which can void any cash discount agreement, and to always demand a full itemized bill rather than accepting a summary invoice. If a patient receives a balance bill for services rendered at this Critical Access Hospital, they should verify the legality of the charge under the No Surprises Act, particularly for emergency care or non-emergency services from out-of-network providers. Disputing unexpected bills in writing is the most effective way to protect against overcharging and ensure the final amount reflects the negotiated or cash rates available.