CMS Price Transparency Data

CT scan, sinuses

Facility: Baldwin Health

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 70486
  • Insurance Median: $224
  • Cash Discount Price: $1,128
  • vs. Medicare Baseline: 2.10x Medicare
The contracted insurance negotiated median rate for a CT scan, sinuses at Baldwin Health is $224. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,128. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.10x the Medicare baseline. Located in 1613 North McKenzie Street, Foley, AL.
Cash / Self-Pay
$1,128

Average discount available for prompt cash payment at this facility.

Insurance Median
$224

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)
Cash / Self-Pay: $1,128 (1056%)
Insurance Median: $224 (210%)
Cash: $1,128 (1056% of Medicare)
Ins. Median: $224 (210% of 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 210% of the Medicare baseline (a markup of 110%). 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.

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group Contract Rate Range vs. Medicare Reference
Medicaid / KanCare $88 82%
Veterans Eval Services $92 86%
Tricare $94 88%
Triwest $97 91%
Blue Cross Blue Shield $98 - $161 92%
Humana $98 92%
Medicare (plans) $98 92%
UnitedHealthcare $98 - $224 92%
Windsor Health Plan $98 92%
Community Hospice $99 93%
Hospice $99 93%
Mercy Medical Hospice $99 93%
Node Champva $99 93%
Node Va $99 93%
Cigna $100 - $375 94%
Node Clover Health Mcr Adv $100 94%
Node Devoted Health Mcr Adv $100 94%
Select Health $100 94%
Aetna $101 - $4,229 95%
Node Wellcare Mcr Adv $101 95%
Us Dol $124 116%
Ambetter / Centene $149 140%
First Choice $161 151%
Alamed $600 562%
Self Pay $846 - $1,410 792%
American Employee Alliance $1,880 1760%
Multiplan $2,678 - $3,853 2507%
First Health $3,524 - $3,794 3299%
Multiplan Inc $3,595 3366%
Coventry Work Comp Al $3,674 3440%
One Health $3,759 3519%
Pro America $3,759 3519%
Novanet $3,794 3552%
Alabama Wc $3,994 3739%
Gulf Health $3,994 3739%
Principal Ppo $3,994 3739%
Viva Health $3,994 3739%
National Health $4,229 3959%
Galaxy $4,276 4003%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1613 North McKenzie Street, Foley, AL 36535
  • CMS Rating: ★★★★☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals