CMS Price Transparency Data

CT scan, sinuses

Facility: Marion Communtiy Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $1,993
Cash Discount Price: $6,635
vs. Medicare Baseline: 18.66x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Marion Communtiy Hospital is $1,993. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,635. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 18.66x the Medicare baseline. Located in 1431 Sw 1St Ave, Ocala, FL.

Cash / Self-Pay

$6,635

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,993

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: $6,635 (6212%)

Insurance Median: $1,993 (1866%)

Cash: $6,635 (6212% of Medicare)

Ins. Median: $1,993 (1866% 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 1866% of the Medicare baseline (a markup of 1766%). 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 - $3,153	229%
Avmed	$856 - $1,863	801%
Simply	$965 - $1,079	903%
Aetna	$968 - $2,102	906%
Molina Healthcare	$1,190 - $2,242	1114%
Sunshine State Health Plan	$1,597 - $1,787	1495%
Corvel Corporation	$1,893	1772%
Prime Health	$1,933	1810%
Careworks (Rockport Community)	$1,993	1866%
Marion County Schools	$1,993	1866%
Plotkin Health	$3,132 - $3,504	2932%
Prime Health Sheriff	$3,132 - $3,504	2932%
Multiplan	$4,885 - $5,465	4574%
Ppo Next	$5,324 - $5,956	4985%
Novanet	$5,637 - $6,306	5278%

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 $6,635.
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 Marion Communtiy 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.