CMS Price Transparency Data

CT scan, sinuses

Facility: Marshfield Medical Center

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $1,289
Cash Discount Price: $1,298
vs. Medicare Baseline: 12.07x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Marshfield Medical Center is $1,289. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,298. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 12.07x the Medicare baseline. Located in 611 St Joseph Ave, Marshfield, WI.

Cash / Self-Pay

$1,298

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,289

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: $1,298 (1215%)

Insurance Median: $1,289 (1207%)

Cash: $1,298 (1215% of Medicare)

Ins. Median: $1,289 (1207% 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 1207% of the Medicare baseline (a markup of 1107%). 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
Family Health Center (Fhc)	$683	639%
Amish/Mennonite	$751	703%
Sanford Health Plan	$751	703%
The Alliance	$949 - $1,141	888%
Group Health Cooperative Of Eau Claire	$1,120 - $1,257	1049%
Besse Forest Products	$1,161	1087%
Molina Healthcare Of Wi	$1,161	1087%
Rice Lake School District	$1,161	1087%
Security Health Plan (Shp)	$1,188 - $1,748	1112%
Wps Health Insurance	$1,205 - $1,318	1128%
Trilogy	$1,229 - $1,311	1151%
UnitedHealthcare	$1,243	1164%
Medica Of Wi	$1,268 - $1,294	1187%
Cigna	$1,284	1202%
Healtheos By Multiplan Inc.	$1,284 - $1,298	1202%
Corvel	$1,298	1215%
First Health	$1,298	1215%
Health Partners	$1,298	1215%
Three Rivers Provider Network (Trpn)	$1,298	1215%
Coventry	$1,311	1227%
Health Smart	$1,311	1227%
Rising Medical Work Comp	$1,325	1241%
Blue Cross Blue Shield	$1,609 - $1,838	1506%

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 $1,298.
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 Marshfield 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.