CMS Price Transparency Data

CT scan, sinuses

Facility: Gundersen St Josephs Hospital and Clinics

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $1,562
Cash Discount Price: $1,212
vs. Medicare Baseline: 14.62x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Gundersen St Josephs Hospital and Clinics is $1,562. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,212. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 14.62x the Medicare baseline. Located in 400 Water Ave, Hillsboro, WI.

Cash / Self-Pay

$1,212

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,562

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: $1,212 (1135%)

Insurance Median: $1,562 (1462%)

Cash: $1,212 (1135% of Medicare)

Ins. Median: $1,562 (1462% 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 1462% of the Medicare baseline (a markup of 1362%). 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
Amerigroup	$46	43%
Blue Cross Blue Shield	$282 - $2,313	264%
Iowa Total Care	$282	264%
Managed Health Service	$282	264%
Security Health Plan	$409	383%
Ucare	$1,085 - $1,669	1016%
UnitedHealthcare	$1,106 - $1,458	1035%
Quartz	$1,137	1065%
Alliance	$1,666 - $1,850	1560%
Cigna	$1,711	1602%
Aspirus Arise Health	$1,731	1621%
Humana	$1,773	1660%
Multiplan/Healtheos	$1,815 - $1,982	1699%
Coventry Health Care	$1,982	1856%

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 $1,212.
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 Gundersen St Josephs Hospital and Clinics 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.