CMS Price Transparency Data

CT scan, sinuses

Facility: Adventist Health St Helena

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $2,185
Cash Discount Price: $672
vs. Medicare Baseline: 20.46x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Adventist Health St Helena is $2,185. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $672. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 20.46x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$672

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,185

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: $672 (629%)

Insurance Median: $2,185 (2046%)

Cash: $672 (629% of Medicare)

Ins. Median: $2,185 (2046% 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 2046% of the Medicare baseline (a markup of 1946%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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
Cigna	$22 - $5,019	21%
Blue Shield Bh Mcr Adv	$44 - $139	41%
Blue Shield Mcr Adv	$44 - $139	41%
Kaiser Mcr Adv	$44 - $139	41%
Tricare	$44 - $139	41%
Ah Employee Health Plan - All Plans	$48 - $250	45%
Interplan-All Plans	$53 - $4,078	50%
Kaiser-All Other Plans	$53 - $5,145	50%
Western Growers-All Plans	$65 - $3,325	61%
Blue Shield Epn-All Other Plans	$78 - $2,955	73%
Blue Shield Non-Epn	$83 - $2,911	78%
Phcs-All Plans	$97 - $3,451	91%
Medi-Cal	$123	115%
UnitedHealthcare	$139 - $4,000	130%
Va Mcr - All Other Plans	$139	130%
Health Management Network-All Plans	$150 - $5,333	140%
Three Rivers-All Plans	$159 - $5,647	149%
Va Medi-Cal	$209	196%
Aetna	$305 - $1,270	286%
Blue Cross Blue Shield	$725 - $966	679%
Healthnet-All Plans	$1,060	992%
Blue Shield Behav Hlth	$1,512 - $2,823	1416%
Choicecare-All Plans	$2,353 - $4,392	2203%
Beech Street-All Plans	$2,521 - $4,706	2360%
Galaxy Network-All Plans	$3,025 - $5,647	2832%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $672.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70486.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health St Helena is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 70486.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.