CMS Price Transparency Data

CT scan, sinuses

Facility: Veterans Memorial Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $789
Cash Discount Price: $717
vs. Medicare Baseline: 7.39x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Veterans Memorial Hospital is $789. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $717. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.39x the Medicare baseline. Located in 40 1St Street Se, Waukon, IA.

Cash / Self-Pay

$717

Average discount available for prompt cash payment at this facility.

Insurance Median

$789

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: $717 (671%)

Insurance Median: $789 (739%)

Cash: $717 (671% of Medicare)

Ins. Median: $789 (739% 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 739% of the Medicare baseline (a markup of 639%). 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
Humana	$32 - $1,376	30%
Aetna	$38 - $1,225	36%
Amerigroup Mcr Adv	$38 - $789	36%
Iowa Total Care Exchange	$38 - $789	36%
Molina Mcr Adv	$38 - $789	36%
Quartz Mcr Adv	$38 - $789	36%
Welmark Mcr Adv	$38 - $789	36%
Quartz Comm - All Other Plans	$65 - $1,376	61%
Amerigroup Mcaid - All Other Plans	$107 - $683	100%
Wellmark Hmo - All Other Plans	$126	118%
Wellmark Ppo	$138	129%
Iowa Total Care Mcaid - All Other Plans	$683 - $935	639%
Molina Mcaid - All Other Plans	$683 - $935	639%
Iowa Total Care Mcr Adv	$789	739%
Medica Mcr Adv	$789	739%
UnitedHealthcare	$789 - $1,559	739%
Medica Comm - All Other Plans	$918	859%

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 $717.
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 Veterans Memorial Hospital 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.