CT scan, sinuses
Facility: Oakleaf Surgical Hospital
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $104
- Cash Discount Price: $1,305
- vs. Medicare Baseline: 0.97x 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 |
|---|---|---|
| Blue Cross Blue Shield | $104 - $1,748 | 97% |
| Dean Health Plan | $104 | 97% |
| Group Health Cooperative Of Eau Claire | $104 | 97% |
| Healthpartners | $104 | 97% |
| Humana | $104 | 97% |
| Medica | $104 | 97% |
| Quartz Health Solutions | $104 | 97% |
| Security Health Plan Of Wi | $104 - $876 | 97% |
| Ucare Wi | $104 | 97% |
| UnitedHealthcare | $104 | 97% |
| Alliance | $518 | 485% |
Consumer Guidance & Cost Commentary
For this CT scan of the sinuses at Oakleaf Surgical Hospital in Altoona, WI, the most significant benchmark is the Medicare amount of $106.81, which serves as the federal government's cost baseline for this service. The facility's cash median price is $1,305, while the gross charge listed on the chargemaster is $1,450. It is important to note that the state and county average data for this specific procedure were not provided in the available information. Since the cash price of $1,305 is higher than the Medicare benchmark of $106.81, patients with high-deductible plans might find it financially advantageous to pay the cash rate directly, provided they have not yet met their deductible, as this avoids the administrative overhead and potential balance billing associated with insurance claims.
Regarding insurance coverage, the facility has negotiated rates with 11 payers, with the lowest negotiated rate being $104 and the highest reaching $1,748 depending on the specific plan. While the median negotiated rate is $104, which is lower than the cash price, patients should be aware that many plans may still require them to pay the full cash amount if they have not met their deductible. To minimize costs, consumers should inquire about "prompt-pay" discounts, which can offer a fee reduction of 20% to 50% for upfront payment, effectively lowering the bill below the standard cash median. Additionally, patients should request an itemized billing audit before finalizing payment to ensure no unbundled codes or services not rendered are included in the final invoice.