CMS Price Transparency Data

CT scan, sinuses

Facility: Norton-King's Daughters' Health

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $795
Cash Discount Price: $250
vs. Medicare Baseline: 7.44x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Norton-King's Daughters' Health is $795. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $250. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.44x the Medicare baseline. Located in 1373 East Sr 62, Madison, IN.

Cash / Self-Pay

$250

Average discount available for prompt cash payment at this facility.

Insurance Median

$795

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: $250 (234%)

Insurance Median: $795 (744%)

Cash: $250 (234% of Medicare)

Ins. Median: $795 (744% 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 744% of the Medicare baseline (a markup of 644%). 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
Aetna	$49 - $795	46%
Blue Cross Blue Shield	$54 - $811	51%
Humana	$54 - $111	51%
Managed Health Services Of Kentucky	$54	51%
Passport By Molina	$54	51%
Managed Health Services Of Indiana	$104	97%
UnitedHealthcare	$104 - $892	97%
Managed Health Services	$115 - $173	108%
Caresource Of Kentucky	$156	146%
Caresource Of Indiana	$167	156%
Custom Design Benefits	$223 - $568	209%
Cigna	$966	904%
Encore	$966	904%
Quality Care Partners	$1,011	947%
Bluegrass	$1,022	957%
First Health	$1,022	957%
Healthlink	$1,022	957%
Vha/Tristate	$1,022	957%
Multiplan/Phcs	$1,045	978%
Indiana Health Network	$1,079	1010%
Siho	$1,079	1010%

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 $250.
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 Norton-King's Daughters' Health 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.