CMS Price Transparency Data

CT scan, sinuses

Facility: Blue Ridge Regional Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $1,608
Cash Discount Price: $3,960
vs. Medicare Baseline: 15.05x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Blue Ridge Regional Hospital is $1,608. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,960. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 15.05x the Medicare baseline. Located in 125 Hospital Drive, Spruce Pine, NC.

Cash / Self-Pay

$3,960

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,608

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: $3,960 (3708%)

Insurance Median: $1,608 (1505%)

Cash: $3,960 (3708% of Medicare)

Ins. Median: $1,608 (1505% 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 1505% of the Medicare baseline (a markup of 1405%). 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	$634 - $664	594%
United	$674 - $1,873	631%
Wellcare	$684	640%
Amerihealth	$691	647%
Partners Health Management	$698	653%
Vaya Health	$698	653%
Aetna	$792 - $2,863	742%
Apex Health	$792	742%
Cigna	$1,346 - $1,620	1260%
Amerihealth Caritas	$1,465	1372%
Caresource	$1,742	1631%
Medcost	$1,845 - $2,050	1727%
Magellan	$2,376	2225%
Magellan Behavioral Health	$2,376	2225%
Multiplan	$3,168	2966%
Avalon Administrative Services	$3,366	3151%
Prime Health	$3,485 - $3,564	3263%

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 $3,960.
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 Blue Ridge Regional 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.