CMS Price Transparency Data
CT scan, sinuses
Facility: Saint Joseph Regional Medical Center - Plymouth
Billing Code: 70486 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 70486
- Insurance Median: $1,637
- Cash Discount Price: $1,773
- vs. Medicare Baseline: 15.33x Medicare
The contracted insurance negotiated median rate for a CT scan, sinuses at Saint Joseph Regional Medical Center - Plymouth is $1,637. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,773. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 15.33x the Medicare baseline. Located in 1915 Lake Ave, Plymouth, IN.
Cash / Self-Pay
$1,773
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,637
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: $1,773 (1660%)
Insurance Median: $1,637 (1533%)
Cash: $1,773 (1660% of Medicare)
Ins. Median: $1,637 (1533% 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 1533% of the Medicare baseline (a markup of 1433%). 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 |
|---|---|---|
| Aetna | $57 - $1,773 | 53% |
| Blue Cross Blue Shield | $57 - $406 | 53% |
| Medicaid / KanCare | $57 - $406 | 53% |
| UnitedHealthcare | $57 - $878 | 53% |
| Medicare (plans) | $111 - $113 | 104% |
| Meridian Complete | $111 | 104% |
| Pace-Trinity Health | $111 | 104% |
| County Coroner | $115 | 108% |
| Provider Partners Health Plan Of Indiana | $122 | 114% |
| Auxiant | $166 - $2,264 | 155% |
| Physicians Health Plan Northern Indiana Health Insurance | $166 - $334 | 155% |
| St Joseph County Hlth Dpt | $166 | 155% |
| Caresource | $171 | 160% |
| Siho Insurance Services | $177 | 166% |
| Key Benefit Administrator | $199 - $1,913 | 186% |
| Allied Benefit Systems | $210 - $1,773 | 197% |
| Custom Design Benefits | $238 | 223% |
| Blue Benefit Administrators Of Massachusetts | $391 | 366% |
| Blue Care Network | $391 | 366% |
| Blue Distinction Transplant | $391 | 366% |
| Blue Shield - Ca | $391 | 366% |
| Blue Shield - Id (Regence) | $391 | 366% |
| Blue Shield - Ny Highmark Northeastern | $391 | 366% |
| Blue Shield - Ny Highmark Western | $391 | 366% |
| Blue Shield - Pa (Highmark) | $391 | 366% |
| Blue Shield - Wa (Regence) | $391 | 366% |
| Managed Health Services - Indiana | $406 | 380% |
| Mdwise | $406 | 380% |
| Plain Church Group | $737 | 690% |
| Geha | $878 | 822% |
| Healthscope | $878 | 822% |
| Student Insurance Cma | $878 | 822% |
| Notre Dame Athletic Association | $1,500 | 1404% |
| Wc Notre Dame | $1,500 | 1404% |
| Luminare Health (Detroit) | $1,555 - $1,637 | 1456% |
| Ameriben | $1,637 | 1533% |
| Asr Health Benefits | $1,773 | 1660% |
| Christian Brother Services | $1,773 | 1660% |
| Employee Benefit Management | $1,773 | 1660% |
| Medical Mutual | $1,773 | 1660% |
| Meritain | $1,773 | 1660% |
| Preferred One | $1,773 | 1660% |
| Rural Carrier Health Benefit Plan | $1,773 | 1660% |
| Webtpa | $1,773 | 1660% |
| Encore Health | $1,913 | 1791% |
| Indiana Criminal Justice Inst | $1,913 | 1791% |
| Western & Southern Financial Group | $1,913 | 1791% |
| Cigna | $1,964 | 1839% |
| Group Administrators | $1,964 | 1839% |
| Health Partners | $1,964 | 1839% |
| Mvp | $1,964 | 1839% |
| Prairie States | $1,964 | 1839% |
| Priority Health | $1,964 | 1839% |
| Professional Benefit Administrators | $1,964 | 1839% |
| Sagamore Health Network | $1,964 - $2,101 | 1839% |
| Sisco Benefits | $1,964 | 1839% |
| Unified Group Services | $1,964 | 1839% |
| Goshen Preferred Network | $2,101 - $2,346 | 1967% |
| Signature Care | $2,264 | 2120% |
| Allied National Global Care | $2,455 | 2298% |
| Asrm - Reliance Standard Life Insurance | $2,455 | 2298% |
| Avmed Health Plan | $2,455 | 2298% |
| Christian Care Ministry | $2,455 | 2298% |
| Dean Health | $2,455 | 2298% |
| Fallon Health | $2,455 | 2298% |
| Family Life Insurance Company | $2,455 | 2298% |
| Freedom Life Insurance Company | $2,455 | 2298% |
| Ghc Scw | $2,455 | 2298% |
| International Benefit Administrators | $2,455 | 2298% |
| Lifetime Benefit Solutions | $2,455 | 2298% |
| Manhattan Life | $2,455 | 2298% |
| Medi Share | $2,455 | 2298% |
| Multiplan | $2,455 | 2298% |
| Pai | $2,455 | 2298% |
| Pan-American Life | $2,455 | 2298% |
| Paramount Hmo | $2,455 | 2298% |
| Phcs | $2,455 | 2298% |
| Philadelphia American Life Insurance | $2,455 | 2298% |
| Trinity Health Share | $2,455 | 2298% |
| Bankers Life Casualty | $2,728 | 2554% |
| Bureau Of Disability | $2,728 | 2554% |
| Wc Align Network | $2,728 | 2554% |