CMS Price Transparency Data

CT scan, sinuses

Facility: Memorial Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $1,873
Cash Discount Price: $1,674
vs. Medicare Baseline: 17.54x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Memorial Hospital is $1,873. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,674. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 17.54x the Medicare baseline. Located in 1454 N County Road 2050 E, Carthage, IL.

Cash / Self-Pay

$1,674

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,873

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: $1,674 (1567%)

Insurance Median: $1,873 (1754%)

Cash: $1,674 (1567% of Medicare)

Ins. Median: $1,873 (1754% 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 1754% of the Medicare baseline (a markup of 1654%). 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	$554 - $2,093	519%
Aetna	$558 - $2,093	522%
Consociate	$558 - $2,093	522%
Blue Cross Blue Shield	$586 - $2,093	549%
Cigna	$586 - $2,093	549%
Health Alliance	$586 - $2,093	549%
Meridian	$586 - $2,093	549%
Molina	$586 - $2,093	549%
UnitedHealthcare	$586 - $2,093	549%
First Health Network	$1,374 - $1,863	1286%
Healthlink	$1,779 - $2,093	1666%
Private Healthcare Systems	$1,779	1666%
Integrated Health Plan	$1,842	1725%
Health Dynamics	$1,884	1764%
Health Payors Org	$1,884	1764%
Iowa Health Solutions	$1,884	1764%
Multiplan	$1,884	1764%
Preferred Plan Inc	$1,884	1764%
Three Rivers Provider Network	$1,884	1764%
Health First Network	$1,905	1784%
Pponext	$1,905	1784%
Corvel	$1,988	1861%

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 $1,674.
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 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.