CT scan, sinuses
Facility: Regional Medical Center
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $870
- Cash Discount Price: $1,080
- vs. Medicare Baseline: 8.15x 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 815% of the Medicare baseline (a markup of 715%). 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 |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 815% |
Consumer Guidance & Cost Commentary
If you are paying cash for this CT scan of the sinuses at Regional Medical Center, the most important number to know first is that the facility's published cash price is $1,080. While this appears to be a standard self-pay rate, patients with high-deductible plans should verify whether their insurance negotiated rate of $870 exceeds this cash price, as paying out-of-pocket could result in a higher total cost than using an in-network plan. It is also critical to ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can significantly lower the final amount owed compared to the listed cash rate.
The broader financial context for this service reveals that the facility's cash rate of $1,080 is higher than the median negotiated rate of $870 and the median paid rate of $504, reflecting the administrative costs and markup inherent in insurance billing structures. For comparison, the Medicare benchmark for this procedure is $106.81, which serves as the federal baseline for evaluating the facility's pricing markup; under fair pricing standards, rates are typically defined as 120% to 150% of this Medicare amount, whereas this facility's cash price represents a significant premium over that baseline. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, they must still carefully review itemized bills to ensure no unbundled charges or services not rendered have been included in the final invoice.