CMS Price Transparency Data

CT scan, sinuses

Facility: Mercy Hospital Southeast

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 70486
  • Insurance Median: $563
  • Cash Discount Price: $1,235
  • vs. Medicare Baseline: 5.27x Medicare
The contracted insurance negotiated median rate for a CT scan, sinuses at Mercy Hospital Southeast is $563. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,235. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.27x the Medicare baseline. Located in 1701 Lacey St, Cape Girardeau, MO.
Cash / Self-Pay
$1,235

Average discount available for prompt cash payment at this facility.

Insurance Median
$563

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: $1,235 (1156%)
Insurance Median: $563 (527%)
Cash: $1,235 (1156% of Medicare)
Ins. Median: $563 (527% 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 527% of the Medicare baseline (a markup of 427%). 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
Imagine 360 Contracted [320494] $67 63%
Medicaid / KanCare $91 - $288 85%
Aetna $100 - $1,227 94%
Blue Cross Blue Shield $100 - $1,821 94%
Cross Timbers Hospice [20098] $100 94%
Dept Of Veteran Affairs Contracted [320106] $100 94%
Elara Caring Aspire Hospice Contracted [320433] $100 94%
Elara Caring Aspire Hospice [20433] $100 94%
Halo Hcr Inc Hospice Contracted [320432] $100 94%
Halo Hcr Inc Hospice [20432] $100 94%
Humana $100 - $1,629 94%
Kindful Hospice Contracted [320434] $100 94%
Kindful Hospice [20434] $100 94%
Medicare (plans) $100 - $105 94%
Mercy Hospice Okc [20252] $100 94%
Pace Of The Ozarks Contracted [320518] $100 94%
Tricare $100 94%
Ambetter / Centene $102 95%
American Health Advantage Of Mo Mcr Hmo Contracted [320264] $102 95%
Home State Health Plan Contracted [320187] $102 95%
Hope Trust Contracted [320488] $102 95%
UnitedHealthcare $102 - $686 95%
Provider Partners Health Plans Contracted [320450] $115 108%
Consociate Consolidated Health Contracted [320490] $140 - $225 131%
Auxiant Contracted [320462] $168 - $200 157%
Centivo Contracted [320505] $168 157%
Ebms Contracted [320493] $168 157%
Healthlink Contracted [320179] $168 - $1,495 157%
Mercy Benefit Admin Contracted [320251] $168 - $1,304 157%
Reflect Health Contracted [320492] $174 163%
Preferred Health Plan Contracted [320522] $178 167%
Cigna $406 380%
United Medical Resources Contracted [320454] $686 642%
First Health Contracted [320128] $1,206 - $1,227 1129%
Health Alliance Contracted [320164] $1,225 - $1,246 1147%
Aither Health Contracted [320449] $1,281 - $1,304 1199%
Edison Health Solutions Contracted [320502] $1,281 - $1,304 1199%
Mercy Benefit Admin [20251] $1,281 - $1,304 1199%
Yuzu Health Contracted [320521] $1,281 - $1,304 1199%
Workers Comp [20426] $1,413 - $1,534 1323%
Multiplan Contracted [320270] $1,507 - $1,534 1411%
Private Health Care Systems Contracted [320320] $1,507 - $1,534 1411%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1701 Lacey St, Cape Girardeau, MO 63701
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals