CMS Price Transparency Data

CT scan, sinuses

Facility: Kaleida Health

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $119
Cash Discount Price: $445
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Kaleida Health is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $445. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.11x the Medicare baseline. Located in 100 High Street, Buffalo, NY.

Cash / Self-Pay

$445

Average discount available for prompt cash payment at this facility.

Insurance Median

$119

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: $445 (417%)

Insurance Median: $119 (111%)

Cash: $445 (417% of Medicare)

Ins. Median: $119 (111% 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.

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
Molina Healthcare Of New York, Inc.	$21 - $80	20%
Univera Healthcare	$32 - $67	30%
UnitedHealthcare	$33 - $142	31%
Fidelis Care	$35 - $67	33%
Highmark Wny	$35 - $48	33%
American Progressive Life & Health	$39	37%
Meritain Health	$61	57%
Independent Health Association	$76 - $249	71%
Independent Health Association - Wchob	$79 - $249	74%
Blue Cross Blue Shield	$89 - $487	83%
Ghi/Emblem Health	$99 - $176	93%
Ghi/Emblem Health - Wchob	$99 - $124	93%
Aetna	$103 - $138	96%
Magnacare	$103 - $132	96%
Magnacare - Wchob	$103 - $132	96%
Tricare	$124	116%
Univera	$128 - $475	120%
Wellcare	$136	127%
Fidelis	$141	132%
Cigna	$153 - $185	143%
Univera - Wchob	$177 - $475	166%

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 $445.
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 Kaleida 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.