CMS Price Transparency Data

CT scan, sinuses

Facility: Nacogdoches Memorial Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $750
Cash Discount Price: $409
vs. Medicare Baseline: 7.02x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Nacogdoches Memorial Hospital is $750. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $409. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.02x the Medicare baseline. Located in 1204 Mound St, Nacogdoches, TX.

Cash / Self-Pay

$409

Average discount available for prompt cash payment at this facility.

Insurance Median

$750

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: $409 (383%)

Insurance Median: $750 (702%)

Cash: $409 (383% of Medicare)

Ins. Median: $750 (702% 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 702% of the Medicare baseline (a markup of 602%). 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
Humana	$102	95%
Wellmed	$102 - $1,363	95%
Healthspring	$107	100%
Molina	$107 - $1,363	100%
Blue Cross Blue Shield	$145 - $1,090	136%
Galaxy	$171 - $886	160%
Usa Health Network	$197 - $1,022	184%
Aetna	$210 - $1,090	197%
Healthsmart	$210 - $1,090	197%
Phcs	$210 - $1,090	197%
Hiet Benefit Plan	$263 - $1,363	246%
UnitedHealthcare	$391	366%

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 $409.
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 Nacogdoches Memorial 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.