CMS Price Transparency Data

CT scan, sinuses

Facility: Kosciusko Community Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 70486
  • Insurance Median: $1,190
  • Cash Discount Price: $876
  • vs. Medicare Baseline: 11.14x Medicare
The contracted insurance negotiated median rate for a CT scan, sinuses at Kosciusko Community Hospital is $1,190. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $876. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.14x the Medicare baseline. Located in 2101 E Dubois Dr, Warsaw, IN.
Cash / Self-Pay
$876

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,190

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: $876 (820%)
Insurance Median: $1,190 (1114%)
Cash: $876 (820% of Medicare)
Ins. Median: $1,190 (1114% 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 1114% of the Medicare baseline (a markup of 1014%). 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
Veterans Eval Services $98 92%
Tricare $105 98%
UnitedHealthcare $105 - $2,334 98%
Department Of Veterans Affairs $111 104%
Aetna $117 - $2,464 110%
Blue Cross Blue Shield $117 - $455 110%
Humana $117 - $406 110%
Medicare (plans) $117 110%
Mhs $117 - $406 110%
Iu Health $118 110%
Node Non Par Hospice Agree $118 110%
Node Va $118 110%
Node Devoted Health Mcr Adv $119 111%
In Dept Of Correction $123 115%
Node Pphp Mcr Adv $124 116%
Us Department Of Labor $148 139%
Lutheran Advanced Network $178 167%
Lutheran Preferred $178 - $237 167%
Align In Work Comp $190 178%
One Call Work Comp $190 178%
Encore Work Comp In $213 199%
Prime Health Services $213 - $3,473 199%
Managed Health Services Exchange $237 222%
Workers Comp $237 222%
Encore Kba Epo $284 266%
One Call Care Diagnostics Wc $300 281%
Caresource $313 - $406 293%
Encore Kba Ppo $355 332%
Managed Health Services $406 380%
Medicaid / KanCare $406 380%
Amish Aid $420 - $973 393%
Self Pay $420 - $1,806 393%
Trma Inc $595 - $626 557%
Lutheran Preferred Network $626 - $3,705 586%
Physicians Health Plan $738 - $2,134 691%
Php Freedom Network $772 - $1,788 723%
Encore $800 - $1,852 749%
Connecticut General Life Insurance Company $1,178 - $2,728 1103%
Cigna $1,264 - $2,927 1183%
First Health Network $1,500 - $3,473 1404%
Advantage Health $1,660 - $3,844 1554%
Private Healthcare Systems $1,720 - $3,983 1610%
Sagamore $1,760 - $4,353 1648%
Encore Health Network $1,860 - $4,307 1741%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 2101 E Dubois Dr, Warsaw, IN 46580
  • CMS Rating: ★★★★☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals