CMS Price Transparency Data

CT scan, sinuses

Facility: St Joseph's Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 70486
  • Insurance Median: $1,615
  • Cash Discount Price: $1,817
  • vs. Medicare Baseline: 15.12x Medicare
The contracted insurance negotiated median rate for a CT scan, sinuses at St Joseph's Hospital is $1,615. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,817. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 15.12x the Medicare baseline. Located in 12866 Troxler Avenue, Highland, IL.
Cash / Self-Pay
$1,817

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,615

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: $1,817 (1701%)
Insurance Median: $1,615 (1512%)
Cash: $1,817 (1701% of Medicare)
Ins. Median: $1,615 (1512% 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 1512% of the Medicare baseline (a markup of 1412%). 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.

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
Molina Healthcare $215 - $505 201%
Meridian Health Plan $226 212%
UnitedHealthcare $505 - $2,523 473%
Humana $505 473%
Clear Spring Health of Illinois $505 473%
Blue Cross Blue Shield $505 473%
Sae Hospice $505 473%
Aetna $505 - $1,764 473%
Amish Community $706 661%
Naphcare $1,060 992%
Celtic Insurance Company $1,110 1039%
Cigna $1,190 1114%
Hopetrust $1,262 1182%
Claim Doc $1,262 1182%
Caterpillar, Inc. $1,315 1231%
Wellfirst $1,615 1512%
First Health $1,864 1745%
Healthlink $2,145 2008%
Multiplan/Phcs $2,145 2008%
Provider Network of America $2,271 2126%
Healthcare Finest Network (Hfn) $2,271 2126%
Healthscope $2,523 2362%
Interplan $2,523 2362%
Illinois Breast and Cervical Cancer Program $2,523 2362%
Health Alliance Medical Plans $2,523 2362%
Qtc Medical Group of Illinois $2,523 2362%
Current Health Solutions $2,523 2362%
Consociate Group $2,523 2362%
Mental Health Network $2,523 2362%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 12866 Troxler Avenue, Highland, IL 62249
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Critical Access Hospitals