CMS Price Transparency Data

CT scan, sinuses

Facility: Woodlawn Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $457
Cash Discount Price: $1,527
vs. Medicare Baseline: 4.28x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Woodlawn Hospital is $457. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,527. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.28x the Medicare baseline. Located in 1400 E 9Th St, Rochester, IN.

Cash / Self-Pay

$1,527

Average discount available for prompt cash payment at this facility.

Insurance Median

$457

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: $1,527 (1430%)

Insurance Median: $457 (428%)

Cash: $1,527 (1430% of Medicare)

Ins. Median: $457 (428% 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 428% of the Medicare baseline (a markup of 328%). 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
Blue Cross Blue Shield	$104 - $1,547	97%
Caresource Mcaid Hww	$104	97%
Mdwise Excel Hhw & Hcc	$104	97%
Mhs Mcaid Hcc	$104	97%
Mhs Mcaid Hhw	$104	97%
UnitedHealthcare	$104 - $1,547	97%
Aetna	$448 - $1,934	419%
Caresource Mcaid Hip	$448	419%
Caresource Mcr Adv	$448	419%
Humana	$448 - $1,580	419%
Mdwise Mcaid Excel Hip	$448	419%
Mhs Exch Mrktplce-All Other Plans	$448	419%
Mhs Mcaid Hip	$448	419%
Mhs Mcr Adv	$457	428%
Caresource Exch - All Other Plans	$582	545%
Ambetter / Centene	$596	558%
Partners Direct Health-All Plans	$1,384	1296%
Cigna	$1,458 - $1,731	1365%
Parkview Health Plans-All Plans	$1,527	1430%
Sagamore All Other Grps - All Other Plans	$1,710	1601%
Encore Comm-All Plans	$1,731	1621%
Phcs/Multiplan-All Plans	$1,893	1772%
Community Health Alliance-All Plans	$1,934	1811%

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 $1,527.
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 Woodlawn 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.