CMS Price Transparency Data

CT scan, sinuses

Facility: Kenmore Mercy Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 70486
  • Insurance Median: $126
  • Cash Discount Price: $260
  • vs. Medicare Baseline: 1.18x Medicare
The contracted insurance negotiated median rate for a CT scan, sinuses at Kenmore Mercy Hospital is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $260. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.18x the Medicare baseline. Located in 2950 Elmwood Avenue, Kenmore, NY.
Cash / Self-Pay
$260

Average discount available for prompt cash payment at this facility.

Insurance Median
$126

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: $260 (243%)
Insurance Median: $126 (118%)
Cash: $260 (243% of Medicare)
Ins. Median: $126 (118% 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.

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
UnitedHealthcare $61 - $148 57%
Medicaid / KanCare $71 - $198 66%
VA Veterans Affairs [700001] $74 - $107 69%
Univera Healthcare Essential [100170] $76 - $145 71%
Univera Healthcare [100169] $76 - $155 71%
Beacon Essential [350122] $78 - $151 73%
Ghi [100153] $82 - $119 77%
Medicare (plans) $85 - $176 80%
Cigna $86 - $182 81%
Champ VA [700002] $86 - $126 81%
Seneca Nation [450119] $86 - $126 81%
Fallon Health [450115] $86 - $126 81%
Hospice [550001] $86 - $126 81%
Catholic Health Life Pace [400005] $86 - $126 81%
Tricare $86 - $126 81%
Covid19 Hrsa [45013] $86 - $126 81%
Independent Health Essential [100166] $89 - $198 83%
Fidelis Dual Advantage [450120] $91 - $132 85%
Wellcare Fidelis Dual [450451] $91 - $132 85%
Aetna $91 - $132 85%
Humana $91 - $132 85%
Independent Health [100165] $94 - $291 88%
Iha First Choice [800001] $94 - $292 88%
Wellcare [450129] $95 - $138 89%
Fidelis Essential [100163] $95 - $273 89%
Blue Cross Blue Shield $96 - $273 90%
Beacon Health Options [100023] $104 - $151 97%
Fidelis Exchange [100164] $104 - $151 97%
Mvp Healthcare [100168] $115 - $169 108%
Amerigroup [350102] $133 - $195 125%
UPMC Health Plan [100181] $156 - $226 146%
Molina Essential [100167] $164 - $447 154%
Vna Option Mltc [350110] $198 185%
Excellus Rochester McD [350117] $198 185%
Tuscarora Nation [550120] $198 185%
Crime Victims [100176] $198 185%
No Fault [114001] $320 - $426 300%
Federal Workers Compensation [500100] $320 - $426 300%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 2950 Elmwood Avenue, Kenmore, NY 14217
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals