CMS Price Transparency Data

CT scan, sinuses

Facility: Central Florida Lake Monroe Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $3,767
Cash Discount Price: $12,153
vs. Medicare Baseline: 35.27x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Central Florida Lake Monroe Hospital is $3,767. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $12,153. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 35.27x the Medicare baseline. Located in 1401 W Seminole Blvd, Sanford, FL.

Cash / Self-Pay

$12,153

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,767

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: $12,153 (11378%)

Insurance Median: $3,767 (3527%)

Cash: $12,153 (11378% of Medicare)

Ins. Median: $3,767 (3527% 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 3527% of the Medicare baseline (a markup of 3427%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
United	$245 - $5,469	229%
Freedom Health	$875	819%
Optimum	$875	819%
Aetna	$1,186 - $3,646	1110%
Avmed	$1,695 - $6,076	1587%
Simply	$1,871	1752%
Corvel Corporation	$1,988	1861%
Prime Health	$2,030	1901%
Careworks (Rockport Community)	$2,092	1959%
Molina Healthcare	$2,309 - $3,889	2162%
Sunshine State Health Plan	$3,099	2901%
Plotkin Health	$6,076	5689%
Prime Health Sheriff	$6,076	5689%
Multiplan	$9,114 - $10,330	8533%
Three Rivers Provider Network	$9,114	8533%
Ppo Next	$10,330	9671%
Novanet	$10,937	10240%

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 $12,153.
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 Central Florida Lake Monroe 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.