CMS Price Transparency Data

CT scan, sinuses

Facility: Atrium Health Cleveland

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $680
Cash Discount Price: $1,145
vs. Medicare Baseline: 6.37x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Atrium Health Cleveland is $680. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,145. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.37x the Medicare baseline. Located in 201 E Grover St, Shelby, NC.

Cash / Self-Pay

$1,145

Average discount available for prompt cash payment at this facility.

Insurance Median

$680

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: $1,145 (1072%)

Insurance Median: $680 (637%)

Cash: $1,145 (1072% of Medicare)

Ins. Median: $680 (637% 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 637% of the Medicare baseline (a markup of 537%). 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
Cigna	$38 - $1,833	36%
Aetna	$39 - $1,764	37%
Humana	$39 - $121	37%
UnitedHealthcare	$39 - $1,223	37%
Trillium	$47 - $339	44%
Alliance	$48 - $383	45%
Amerihealth Caritas	$48 - $323	45%
Carolina Complete Health	$48 - $329	45%
Healthy Blue	$48 - $329	45%
Partners	$48 - $321	45%
Vaya	$48 - $333	45%
Wellcare	$48 - $329	45%
Blue Cross Blue Shield	$515 - $680	482%
Ambetter / Centene	$732 - $832	685%
Employers Health Network	$1,013	948%
Physician Reach Out	$1,145	1072%
Medcost	$1,278 - $1,519	1197%
Magellan	$1,374	1286%
Gmmi	$1,489	1394%
Quik Trip	$1,489	1394%
Carolina Behavioral Health	$1,649 - $1,833	1544%
Healthgram	$1,833	1716%
Choicecare	$1,878	1758%
First Health	$1,947	1823%
Lifesynch Community Choice Care	$1,947	1823%
Private Health Care Systems	$2,062	1931%
Beechstreet	$2,107	1973%
Multiplan	$2,176	2037%

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 $1,145.
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 Atrium Health Cleveland 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.