CMS Price Transparency Data

CT scan, sinuses

Facility: HSHS St Elizabeth's Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 70486
  • Insurance Median: $2,826
  • Cash Discount Price: $2,560
  • vs. Medicare Baseline: 26.46x Medicare
The contracted insurance negotiated median rate for a CT scan, sinuses at HSHS St Elizabeth's Hospital is $2,826. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,560. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 26.46x the Medicare baseline. Located in One St Elizabeth Boulevard, O Fallon, IL.
Cash / Self-Pay
$2,560

Average discount available for prompt cash payment at this facility.

Insurance Median
$2,826

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: $2,560 (2397%)
Insurance Median: $2,826 (2646%)
Cash: $2,560 (2397% of Medicare)
Ins. Median: $2,826 (2646% 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 2646% of the Medicare baseline (a markup of 2546%). 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
Molina Healthcare $97 - $124 91%
Meridian Health Plan $102 95%
Aetna $119 - $2,503 111%
Blue Cross Blue Shield $119 - $3,555 111%
Clear Spring Health Of Illinois $119 111%
Health Alliance Medical Plans $119 - $3,022 111%
Health Partners $119 111%
Humana $119 111%
Sae Hospice $119 111%
UnitedHealthcare $119 - $3,555 111%
Celtic Insurance Company $237 222%
Naphcare $257 241%
Hopetrust $285 267%
Claim Doc $297 278%
Amish Community $995 932%
Wellfirst $2,289 2143%
Cigna $2,290 - $3,555 2144%
First Health $2,645 2476%
Healthlink $2,826 - $3,555 2646%
Caterpillar, Inc. $2,855 2673%
Consociate Group $3,128 2929%
Choicecare $3,200 2996%
Healthcare Finest Network (Hfn) $3,200 2996%
Multiplan/Phcs $3,200 2996%
Provider Network Of America $3,200 2996%
City Of Springfield $3,555 3328%
Current Health Solutions $3,555 3328%
Healthscope $3,555 3328%
Illinois Breast And Cervical Cancer Program $3,555 3328%
Interplan $3,555 3328%
Live360 $3,555 3328%
Wexford $3,555 3328%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: One St Elizabeth Boulevard, O Fallon, IL 62269
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals