CMS Price Transparency Data

CT scan, sinuses

Facility: Sanford Clear Lake Medical Center

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $2,182
Cash Discount Price: $2,128
vs. Medicare Baseline: 20.43x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Sanford Clear Lake Medical Center is $2,182. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,128. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 20.43x the Medicare baseline. Located in 701 Third Avenue South, Clear Lake, SD.

Cash / Self-Pay

$2,128

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,182

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: $2,128 (1992%)

Insurance Median: $2,182 (2043%)

Cash: $2,128 (1992% of Medicare)

Ins. Median: $2,182 (2043% 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 2043% of the Medicare baseline (a markup of 1943%). 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	$705	660%
Sanford Health Plan Align	$1,365	1278%
Security Health Plan	$1,463	1370%
Ucare	$1,466 - $2,337	1373%
Wellmark Sd	$1,466	1373%
Aetna	$1,479 - $2,312	1385%
Health Partners	$1,479 - $1,995	1385%
Medicare (plans)	$1,479	1385%
UnitedHealthcare	$1,479 - $2,221	1385%
Primewest	$1,508	1412%
Sanford Health Plan	$1,844 - $2,474	1726%
Medica	$2,194 - $2,346	2054%
Wellmark	$2,288 - $2,314	2142%
Cigna	$2,394	2241%
First Choice Health Network	$2,394	2241%
Healthez	$2,394	2241%
Multiplan	$2,394	2241%

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 $2,128.
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 Sanford Clear Lake Medical Center 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.