CMS Price Transparency Data

CT scan, sinuses

Facility: Lexington Memorial Hospital Inc

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $1,018
Cash Discount Price: $1,143
vs. Medicare Baseline: 9.53x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Lexington Memorial Hospital Inc is $1,018. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,143. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.53x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$1,143

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,018

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: $1,143 (1070%)

Insurance Median: $1,018 (953%)

Cash: $1,143 (1070% of Medicare)

Ins. Median: $1,018 (953% 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 953% of the Medicare baseline (a markup of 853%). 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
Amerihealth	$430 - $628	403%
Carolina Complete	$430	403%
Healthy Blue	$430	403%
Partners	$430	403%
UnitedHealthcare	$435 - $1,024	407%
Vaya	$435	407%
Wellcare	$435	407%
Alliance	$439	411%
Trillium	$444	416%
Medcost	$500 - $1,529	468%
Blue Cross Blue Shield	$638 - $1,023	597%
Aetna	$649 - $2,111	608%
Ambetter / Centene	$656	614%
Oscar	$731 - $1,005	684%
Cigna	$994 - $1,012	931%
Directnet	$1,350	1264%
Healthgram Lexington Home Brands	$1,645	1540%
Healthgram	$1,828	1711%
Private Healthcare Systems	$1,874	1755%
Beechstreet	$2,011	1883%
Humana	$2,011	1883%
Multiplan	$2,056	1925%
National Provider Network	$2,056	1925%

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 $1,143.
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 Lexington Memorial Hospital Inc 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.