CMS Price Transparency Data

CT scan, sinuses

Facility: Unity Physicians Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $97
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Unity Physicians Hospital is $97. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.91x the Medicare baseline. Located in 4455 Edison Lakes Pkwy, Mishawaka, IN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$97

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%)

Insurance Median: $97 (91%)

Ins. Median: $97 (91% 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.

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
Aarp Supplemental	$97	91%
Aetna	$97	91%
Blue Cross Blue Shield	$97 - $104	91%
Cigna	$97	91%
Department Of Va	$97	91%
Medicare (plans)	$97	91%
Mhs Healthy Indiana Plan	$97	91%
Railroad Retirement	$97	91%
UnitedHealthcare	$97	91%
Medicaid / KanCare	$104	97%
Mhs Hoosier Care Connect	$104	97%
Three Rivers Provider Network	$117	110%
Humana	$136	127%
Encore	$175	164%
Provider Network Of America	$194	182%
Nalc	$403	377%
Sagamore Health Network	$403	377%
Multiplan	$437	409%
Multiplan Wc	$537	503%

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 $X.
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 Unity Physicians Hospital 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.