CMS Price Transparency Data

CT scan, sinuses

Facility: Kirby Medical Center

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $162
Cash Discount Price: $2,220
vs. Medicare Baseline: 1.52x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Kirby Medical Center is $162. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,220. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.52x the Medicare baseline. Located in 1000 Medical Center Drive, Monticello, IL.

Cash / Self-Pay

$2,220

Average discount available for prompt cash payment at this facility.

Insurance Median

$162

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: $2,220 (2078%)

Insurance Median: $162 (152%)

Cash: $2,220 (2078% of Medicare)

Ins. Median: $162 (152% 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.

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	$32 - $3,626	30%
Aetna	$40 - $2,590	37%
Meridian	$40 - $1,147	37%
UnitedHealthcare	$40 - $2,549	37%
Wellcare	$40 - $1,147	37%
Molina	$41 - $1,181	38%
Zelis (Hfn)	$50 - $3,330	47%
Catepillar, Inc.	$80 - $3,145	75%
Humana	$166 - $2,775	155%
Healthlink	$306 - $3,330	286%
Multiplan/Phcs	$306 - $3,515	286%
Cigna	$2,960	2771%

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 $2,220.
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 Kirby Medical Center 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.