CMS Price Transparency Data

CT scan, head (with contrast)

Facility: Pinckneyville Community Hospital

Billing Code: 70460 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70460
Insurance Median: $1,090
Cash Discount Price: $1,648
vs. Medicare Baseline: 6.08x Medicare

The contracted insurance negotiated median rate for a CT scan, head (with contrast) at Pinckneyville Community Hospital is $1,090. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,648. Compared to the federal Medicare reimbursement reference rate of $179.2, this hospital’s rate is 6.08x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$1,648

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,090

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$179.2

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $179.2 (100%)

Cash / Self-Pay: $1,648 (920%)

Insurance Median: $1,090 (608%)

Cash: $1,648 (920% of Medicare)

Ins. Median: $1,090 (608% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $179.2 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 608% of the Medicare baseline (a markup of 508%). 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
Umwa Mcr Adv - All Plans	$52 - $1,090	29%
UnitedHealthcare	$52 - $2,415	29%
Wellcare Mcr Adv - All Plans	$52 - $1,090	29%
Aetna	$53 - $2,650	30%
Humana	$54 - $1,090	30%
Cigna	$63 - $2,430	35%
Blue Cross Blue Shield	$125 - $2,120	70%
Healthlink Hmo	$217 - $2,312	121%
Healthlink Ppo - All Other Plans	$217 - $2,430	121%
Phcs Savility	$298 - $2,503	166%
Multiplan - All Plans	$315 - $2,650	176%
Phcs - All Other Plans	$315 - $2,415	176%
Ambetter / Centene	$326 - $1,659	182%
Medicaid / KanCare	$326 - $1,659	182%
Healthlink Work Comp	$2,430	1356%

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 $1,648.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70460.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Pinckneyville Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 70460.
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.