CMS Price Transparency Data

CT scan, sinuses

Facility: Lee County Community Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $499
Cash Discount Price: $522
vs. Medicare Baseline: 4.67x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Lee County Community Hospital is $499. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $522. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.67x the Medicare baseline. Located in 127 Health Care Drive, Pennington Gap, VA.

Cash / Self-Pay

$522

Average discount available for prompt cash payment at this facility.

Insurance Median

$499

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: $522 (489%)

Insurance Median: $499 (467%)

Cash: $522 (489% of Medicare)

Ins. Median: $499 (467% 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 467% of the Medicare baseline (a markup of 367%). 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
UnitedHealthcare	$173 - $2,269	162%
Blue Cross Blue Shield	$194 - $2,269	182%
Optima Health	$194	182%
Aetna	$201 - $2,269	188%
Molina Healthcare	$201 - $519	188%
Cigna	$427 - $2,269	400%
Ambetter / Centene	$499	467%
Amerigroup	$499 - $2,269	467%
Managed Medicaire	$499	467%
Medicare (plans)	$499	467%
Mountain Empire Pace	$499	467%
Sentara Health	$499 - $586	467%
United Mine Workers Of America	$499	467%
Humana	$507	475%
Devoted Health Plan	$524	491%
Nhc Advantage	$524	491%
Seven Corners, Inc.	$1,198	1122%
First Health Coventry	$2,269	2124%
Medcost	$2,269	2124%

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 $522.
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 Lee County Community 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.