CMS Price Transparency Data

CT scan, sinuses

Facility: Orange City Area Health System

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $288
Cash Discount Price: $469
vs. Medicare Baseline: 2.70x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Orange City Area Health System is $288. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $469. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.70x the Medicare baseline. Located in 1000 Lincoln Circle Se, Orange City, IA.

Cash / Self-Pay

$469

Average discount available for prompt cash payment at this facility.

Insurance Median

$288

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: $469 (439%)

Insurance Median: $288 (270%)

Cash: $469 (439% of Medicare)

Ins. Median: $288 (270% 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 270% of the Medicare baseline (a markup of 170%). 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
UnitedHealthcare	$67 - $942	63%
Sanford Health-All Plans	$78 - $995	73%
Wellmark Hmo	$78 - $480	73%
Avera-All Plans	$84 - $1,016	79%
Health Partners Coordinated-All Other Plans	$88 - $942	82%
Midlands Choice-All Plans	$89 - $942	83%
Wellmark Ppo - All Other Plans	$92 - $529	86%
Health Partners Open	$96 - $942	90%

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 $469.
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 Orange City Area Health 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.