CMS Price Transparency Data

CT scan, sinuses

Facility: Clay County Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $121
Cash Discount Price: $2,508
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Clay County Hospital is $121. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,508. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.13x the Medicare baseline. Located in 911 Stacy Burk Dr, Flora, IL.

Cash / Self-Pay

$2,508

Average discount available for prompt cash payment at this facility.

Insurance Median

$121

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: $2,508 (2348%)

Insurance Median: $121 (113%)

Cash: $2,508 (2348% of Medicare)

Ins. Median: $121 (113% 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
Aetna	$40 - $1,981	37%
Ambetter / Centene	$40 - $677	37%
Medica(Wellfirst)	$40 - $1,555	37%
Meridian	$40 - $677	37%
UnitedHealthcare	$40 - $2,006	37%
Wellcare	$40 - $677	37%
Blue Cross Blue Shield	$42 - $1,841	39%
Molina	$42 - $85	39%
Healthlink	$205 - $2,006	192%
Cigna	$253 - $2,006	237%
Usa Mco	$300 - $2,383	281%

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 $2,508.
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 Clay County 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.