CMS Price Transparency Data
CT scan, sinuses
Facility: Mercy Health Lakeshore Campus
Billing Code: 70486 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 70486
- Insurance Median: $1,158
- Cash Discount Price: $841
- vs. Medicare Baseline: 10.84x Medicare
The contracted insurance negotiated median rate for a CT scan, sinuses at Mercy Health Lakeshore Campus is $1,158. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $841. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.84x the Medicare baseline. Located in 72 South State Street, Shelby, MI.
Cash / Self-Pay
$841
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,158
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: $841 (787%)
Insurance Median: $1,158 (1084%)
Cash: $841 (787% of Medicare)
Ins. Median: $1,158 (1084% 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 1084% of the Medicare baseline (a markup of 984%). 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $79 - $317 | 74% |
| Medicaid / KanCare | $79 - $80 | 74% |
| Wellpath | $156 | 146% |
| Access Health | $226 | 212% |
| U Of M Health Plan | $284 - $1,158 | 266% |
| Blue Care Network Advantage | $317 | 297% |
| Medicare (plans) | $317 | 297% |
| Aetna | $324 | 303% |
| Align Senior Care | $324 | 303% |
| Correctional Recovery | $324 | 303% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $365 | 342% |
| Oscar | $398 | 373% |
| Vitalcore | $431 | 404% |
| UnitedHealthcare | $453 - $1,165 | 424% |
| Molina Marketplace | $538 | 504% |
| Hospice Of Michigan | $712 | 667% |
| Nomi Health | $725 | 679% |
| Hap | $969 - $1,188 | 907% |
| Wc Accident Fund | $1,021 | 956% |
| Wc Advantage | $1,021 | 956% |
| Wc Aig | $1,021 | 956% |
| Wc Allied | $1,021 | 956% |
| Wc Amerisure | $1,021 | 956% |
| Wc Amtrust | $1,021 | 956% |
| Wc Asu Risk Mgt | $1,021 | 956% |
| Wc Berkley Admin | $1,021 | 956% |
| Wc Broadspire | $1,021 | 956% |
| Wc Bunch & Associates | $1,021 | 956% |
| Wc Ccmsi | $1,021 | 956% |
| Wc Emc Insurance Company | $1,021 | 956% |
| Wc Esis | $1,021 | 956% |
| Wc Fcci | $1,021 | 956% |
| Wc Federated | $1,021 | 956% |
| Wc Gallagher Bassett | $1,021 | 956% |
| Wc Genex Care For Ohio | $1,021 | 956% |
| Wc Guard Insurance Company | $1,021 | 956% |
| Wc Hartford | $1,021 | 956% |
| Wc Liberty Mutual | $1,021 | 956% |
| Wc Meijers | $1,021 | 956% |
| Wc Michigan | $1,021 | 956% |
| Wc Mitchell Frankenmuth | $1,021 | 956% |
| Wc Pma | $1,021 | 956% |
| Wc Sedgwick | $1,021 | 956% |
| Wc Sentry | $1,021 | 956% |
| Wc Travelers | $1,021 | 956% |
| Wc Tristar | $1,021 | 956% |
| Wc Walmart | $1,021 | 956% |
| Wc Zurich | $1,021 | 956% |
| Asr Health Benefits | $1,078 | 1009% |
| 1199 National Benefit Fund | $1,113 | 1042% |
| Allied National Global Care | $1,113 | 1042% |
| Asrm - Reliance Standard Life Insurance | $1,113 | 1042% |
| Christian Care Ministry | $1,113 | 1042% |
| Dean Health | $1,113 | 1042% |
| Fallon Health | $1,113 | 1042% |
| Family Life Insurance Company | $1,113 | 1042% |
| Ghc Scw | $1,113 | 1042% |
| Group Pension Administrators | $1,113 | 1042% |
| International Benefit Administrators | $1,113 | 1042% |
| Lifetime Benefit Solutions | $1,113 | 1042% |
| Manhattan Life | $1,113 | 1042% |
| Medi Share | $1,113 | 1042% |
| Multiplan | $1,113 | 1042% |
| Mvp | $1,113 | 1042% |
| Pai | $1,113 | 1042% |
| Pan-American Life | $1,113 | 1042% |
| Paramount Hmo | $1,113 | 1042% |
| Phcs | $1,113 | 1042% |
| Trinity Health Share | $1,113 | 1042% |
| Cigna | $1,123 | 1051% |
| Caresource | $1,155 | 1081% |
| Acclaim | $1,158 | 1084% |
| Administrative Concepts | $1,158 | 1084% |
| Allegeant | $1,158 | 1084% |
| Allied Benefit Systems | $1,158 | 1084% |
| Ameriben | $1,158 | 1084% |
| American Family | $1,158 | 1084% |
| American Healthcare Alliance | $1,158 | 1084% |
| American Republic | $1,158 | 1084% |
| Amerihealth | $1,158 | 1084% |
| Aultcare | $1,158 | 1084% |
| Automated Benefit Services | $1,158 | 1084% |
| Auxiant | $1,158 | 1084% |
| Benefit Administrative Systems,Llc | $1,158 | 1084% |
| Boon Chapman | $1,158 | 1084% |
| Cam Administrative Services | $1,158 | 1084% |
| Christian Brother Services | $1,158 | 1084% |
| Christian Brothers Holy Cross | $1,158 | 1084% |
| Claimchoice Adminstrators | $1,158 | 1084% |
| Comprehensive Benefits | $1,158 | 1084% |
| Consociate | $1,158 | 1084% |
| Continental Life Insurance | $1,158 | 1084% |
| Custom Benefit Administrators | $1,158 | 1084% |
| Cypress Benefit Administrators | $1,158 | 1084% |
| Employee Benefit Concepts | $1,158 | 1084% |
| Employee Benefit Management | $1,158 | 1084% |
| Enterprise Group Planning | $1,158 | 1084% |
| Forest County Potawatomi | $1,158 | 1084% |
| Freedom Life Insurance Company | $1,158 | 1084% |
| Group Administrators | $1,158 | 1084% |
| Group Marketing Services | $1,158 | 1084% |
| Guardian | $1,158 | 1084% |
| Health America | $1,158 | 1084% |
| Health Choices | $1,158 | 1084% |
| Health Smart | $1,158 | 1084% |
| Healthez | $1,158 | 1084% |
| Healthgram | $1,158 | 1084% |
| Healthscope | $1,158 | 1084% |
| Humana | $1,158 | 1084% |
| Insight | $1,158 | 1084% |
| Intercare | $1,158 | 1084% |
| Jfp Benefit Management | $1,158 | 1084% |
| Jp Farley Corporation | $1,158 | 1084% |
| Key Benefit Administrator | $1,158 | 1084% |
| Liberty Union Life Assurance Co | $1,158 | 1084% |
| Lucent Health | $1,158 | 1084% |
| Luminare Health | $1,158 | 1084% |
| Luminare Health (Detroit) | $1,158 | 1084% |
| Medben | $1,158 | 1084% |
| Medcost | $1,158 | 1084% |
| Medical Mutual | $1,158 | 1084% |
| Mutual Health Services | $1,158 | 1084% |
| Mutual Of Omaha | $1,158 | 1084% |
| Ncas | $1,158 | 1084% |
| Nippon Life Ins | $1,158 | 1084% |
| Nova | $1,158 | 1084% |
| Painters Union Insurance Fund | $1,158 | 1084% |
| Physicians Mutual | $1,158 | 1084% |
| Plumbers Local 98 Insurance Fund | $1,158 | 1084% |
| Prairie States | $1,158 | 1084% |
| Primary Physician Care | $1,158 | 1084% |
| Professional Benefit Administrators | $1,158 | 1084% |
| Secureone Preferred United Plans | $1,158 | 1084% |
| The Loomis Company | $1,158 | 1084% |
| Trustmark Small Business Benefits | $1,158 | 1084% |
| Unicare | $1,158 | 1084% |
| Unified Group Services | $1,158 | 1084% |
| Us Health And Life | $1,158 | 1084% |
| Valenz | $1,158 | 1084% |
| Varipro | $1,158 - $1,188 | 1084% |
| Western & Southern Financial Group | $1,158 | 1084% |
| Wps | $1,158 | 1084% |
| Geha | $1,165 | 1091% |
| Priority Health | $1,166 | 1092% |
| First Health | $1,170 | 1095% |