CMS Price Transparency Data

CT scan, sinuses

Facility: Madison County Health Care System

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $1,185
Cash Discount Price: $1,458
vs. Medicare Baseline: 11.09x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Madison County Health Care System is $1,185. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,458. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.09x the Medicare baseline. Located in 300 West Hutchings Street, Winterset, IA.

Cash / Self-Pay

$1,458

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,185

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: $1,458 (1365%)

Insurance Median: $1,185 (1109%)

Cash: $1,458 (1365% of Medicare)

Ins. Median: $1,185 (1109% 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 1109% of the Medicare baseline (a markup of 1009%). 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
Blue Cross Blue Shield	$480 - $529	449%
Aetna	$784 - $1,185	734%
Medical Associates Hp - All Plans	$784	734%
Medigold-All Plans	$784	734%
Tricare	$784	734%
UnitedHealthcare	$784 - $1,641	734%
American Hp Mcr Adv-All Plans	$823	771%
Iowa Total Care Mcaid-All Plans	$857	802%
Molina Mcaid/Chip -All Plans	$887	830%
Amerigroup Mcaid-All Plans	$908	850%
Madison County Sheriff-All Plans	$912	854%
Oscar - All Plans	$1,176	1101%
Corvel Wc-All Plans	$1,641	1536%
Choicecare-All Plans	$1,732	1622%
First Choice-All Plans	$1,732	1622%
First Health-All Plans	$1,732	1622%
Integrated Hp-All Plans	$1,732	1622%
Mutual Of Omaha-All Plans	$1,732	1622%
Plaines Health-All Plans	$1,732	1622%
Preferred Hlth Ntwork-All Plans	$1,732	1622%
Principal Healthcare-All Plans	$1,732	1622%
Usa Managed Care-All Plans	$1,732	1622%
Medimore Employee Hp - All Plans	$1,787	1673%
Midlands Choice - All Plans	$1,787	1673%
Benefit Admin Of America-All Plans	$1,823	1707%

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 $1,458.
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 Madison County Health Care System 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.