CT scan, sinuses
Facility: Aurora Medical Center
Billing Code: 70486 (CPT)
- CPT Billing Code: 70486
- Insurance Median: $1,014
- Cash Discount Price: $1,470
- vs. Medicare Baseline: 9.49x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 949% of the Medicare baseline (a markup of 849%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aurora Caregiver | $475 | 445% |
| UnitedHealthcare | $538 - $2,475 | 504% |
| Blue Cross Blue Shield | $556 - $2,499 | 521% |
| Healthpartners | $796 - $2,205 | 745% |
| Molina Exchange | $796 | 745% |
| Common Ground | $812 | 760% |
| Centivo | $820 | 768% |
| Aetna | $836 - $2,428 | 783% |
| Health Payment Systems | $875 | 819% |
| Quartz One | $900 | 843% |
| Everpointe Elite | $983 | 920% |
| Quartz Group | $1,000 | 936% |
| Hs Technology | $1,014 | 949% |
| Wisconsin Physician Service | $1,128 - $1,187 | 1056% |
| Trilogy | $1,170 | 1095% |
| Cigna | $1,700 - $2,487 | 1592% |
| Health Eos Plus | $1,764 | 1652% |
| Health Eos | $2,352 | 2202% |
Consumer Guidance & Cost Commentary
For a CT scan of the sinuses at Aurora Medical Center in Grafton, WI, the cash median rate is $1,470. This facility is a voluntary non-profit acute care hospital located at 975 Port Washington Road. While the gross charge for this procedure is $2,940, the median negotiated rate across 18 payers is $1,014, and the median paid amount is $714. Patients should note that cash-pay rates can sometimes be more advantageous than insurance negotiated rates if a patient has a high deductible plan, as the insurance allowed amount may exceed the cash price. It is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill.
The Medicare amount for this service is $106.81, which serves as a benchmark for the true cost of care. The data indicates a Medicare markup factor of 9.5x relative to the Medicare rate. While the provided data includes specific payer ranges—such as UnitedHealthcare with a high of $2,475 and a low of $538, and Aetna with a high of $2,428 and a low of $836—it does not include specific averages or comparisons to Wisconsin or Grafton county state averages for this procedure. Consumers are encouraged to review their specific plan's allowed amounts, as some payers may offer rates significantly higher or lower than the facility's median negotiated price.