CMS Price Transparency Data

CT scan, sinuses

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $1,138
Cash Discount Price: $776
vs. Medicare Baseline: 10.65x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Carilion Stonewall Jackson Hospital is $1,138. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $776. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.65x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.

Cash / Self-Pay

$776

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,138

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: $776 (727%)

Insurance Median: $1,138 (1065%)

Cash: $776 (727% of Medicare)

Ins. Median: $1,138 (1065% 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 1065% of the Medicare baseline (a markup of 965%). 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
Aetna	$92 - $1,471	86%
Humana	$94 - $123	88%
Blue Cross Blue Shield	$100 - $488	94%
UnitedHealthcare	$101 - $1,811	95%
Sentara Health Plan	$103 - $1,374	96%
Abh of VA (Formerly Coventry)	$123	115%
Abh of Wva (Formerly Coventry)	$123	115%
Gateway - Tier 3	$1,219	1141%
Vhn - Ultra	$1,374	1286%
Connecticare	$1,551	1452%
Gateway - Tier 2	$1,773	1660%
Vhn - Plus	$1,773	1660%
Cigna	$1,775	1662%
Integrated Health Plan	$1,884	1764%
Vhn	$1,884	1764%
Vhn - Link	$1,994	1867%
Beech Street	$2,039	1909%
Vhn - Secondary Payors	$2,105	1971%
Gateway - Tier 1	$2,105	1971%

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 $776.
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 Carilion Stonewall Jackson 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.