CMS Price Transparency Data
CT scan, sinuses
Facility: Mercy Hospital Carthage
Billing Code: 70486 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 70486
- Insurance Median: $846
- Cash Discount Price: $966
- vs. Medicare Baseline: 7.92x Medicare
The contracted insurance negotiated median rate for a CT scan, sinuses at Mercy Hospital Carthage is $846. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $966. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.92x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.
Cash / Self-Pay
$966
Average discount available for prompt cash payment at this facility.
Insurance Median
$846
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: $966 (904%)
Insurance Median: $846 (792%)
Cash: $966 (904% of Medicare)
Ins. Median: $846 (792% 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 792% of the Medicare baseline (a markup of 692%). 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 | $60 - $543 | 56% |
| Medicaid / KanCare | $60 - $1,085 | 56% |
| Aetna | $76 - $1,759 | 71% |
| Humana | $76 - $593 | 71% |
| Medicare (plans) | $100 - $585 | 94% |
| UnitedHealthcare | $140 - $1,719 | 131% |
| Cherokee Nation Health Serv Contracted [320066] | $273 - $543 | 256% |
| Cigna | $273 - $1,778 | 256% |
| Cross Timbers Hospice [20098] | $273 - $543 | 256% |
| Dept Of Veteran Affairs Contracted [320106] | $273 - $543 | 256% |
| Elara Caring Aspire Hospice [20433] | $273 - $543 | 256% |
| Globalhealth Contracted [320145] | $273 - $543 | 256% |
| Halo Hcr Inc Hospice Contracted [320432] | $273 - $543 | 256% |
| Halo Hcr Inc Hospice [20432] | $273 - $543 | 256% |
| Indian Health Service Contracted [320198] | $273 - $543 | 256% |
| Kindful Hospice Contracted [320434] | $273 - $543 | 256% |
| Kindful Hospice [20434] | $273 - $543 | 256% |
| Medical Associates Health Contracted [320444] | $273 - $543 | 256% |
| Mercy Hospice Okc [20252] | $273 - $543 | 256% |
| Mercy Mgd Behavioral Health Contracted [320259] | $273 - $543 | 256% |
| Pace Of The Ozarks Contracted [320518] | $273 - $543 | 256% |
| Provider Partners Health Plans Contracted [320450] | $273 - $543 | 256% |
| Qual Choice Contracted [320325] | $273 - $543 | 256% |
| Tricare | $274 - $545 | 257% |
| Point C Contracted [320238] | $348 - $1,778 | 326% |
| Health Systems Inc Contracted [320174] | $428 - $850 | 401% |
| Insurance System Inc Contracted [320465] | $428 - $850 | 401% |
| Administrative Payor Contracted [320005] | $448 - $889 | 419% |
| Centivo Contracted [320505] | $458 - $909 | 429% |
| Healthscope Contracted [320182] | $518 - $1,030 | 485% |
| Ambetter / Centene | $546 - $1,085 | 511% |
| Home State Health Plan Contracted [320187] | $546 - $1,085 | 511% |
| Novasys Contracted [320285] | $546 - $1,085 | 511% |
| Benefit Management Contracted [320052] | $597 - $1,719 | 559% |
| Auxiant Contracted [320462] | $647 - $1,680 | 606% |
| Healthlink Contracted [320179] | $647 - $1,838 | 606% |
| Preferred Health Plan Contracted [320522] | $647 - $1,284 | 606% |
| Workers Comp [20426] | $796 - $1,976 | 745% |
| 90 Degree Benefits Contracted [320436] | $846 - $1,680 | 792% |
| Aither Health Contracted [320449] | $846 - $1,680 | 792% |
| Ebms Contracted [320493] | $846 - $1,680 | 792% |
| Edison Health Solutions Contracted [320502] | $846 - $1,680 | 792% |
| Imagine 360 Contracted [320494] | $846 - $1,680 | 792% |
| Mercy Benefit Admin Contracted [320251] | $846 - $1,778 | 792% |
| Reflect Health Contracted [320492] | $846 - $1,680 | 792% |
| Show-Me Health Administrators Contracted [320483] | $846 - $1,680 | 792% |
| Yuzu Health Contracted [320521] | $846 - $1,680 | 792% |
| Medica Contracted [320239] | $862 - $1,711 | 807% |
| Evolutions Health Care Contracted [320124] | $866 - $1,719 | 811% |
| First Health Contracted [320128] | $866 - $1,719 | 811% |
| Multiplan Contracted [320270] | $866 - $1,719 | 811% |
| Private Health Care Systems Contracted [320320] | $866 - $1,719 | 811% |
| American Healthcare Alliance Contracted [320020] | $896 - $1,778 | 839% |
| Ppo Plus Contracted [320310] | $896 - $1,778 | 839% |
| United Medical Resources Contracted [320454] | $896 - $1,778 | 839% |
| Usa Managed Care Org Contracted [320429] | $896 - $1,778 | 839% |