CMS Price Transparency Data

CT scan, sinuses

Facility: Gulf Breeze Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $872
Cash Discount Price: $904
vs. Medicare Baseline: 8.16x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Gulf Breeze Hospital is $872. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $904. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.16x the Medicare baseline. Located in 1110 Gulf Breeze Pkwy, Gulf Breeze, FL.

Cash / Self-Pay

$904

Average discount available for prompt cash payment at this facility.

Insurance Median

$872

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: $904 (846%)

Insurance Median: $872 (816%)

Cash: $904 (846% of Medicare)

Ins. Median: $872 (816% 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 816% of the Medicare baseline (a markup of 716%). 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
Aetna	$68 - $4,398	64%
Cha Health Plan	$68	64%
UnitedHealthcare	$68 - $1,900	64%
Humana	$72 - $109	67%
Sunshine Health	$72	67%
Wellcare	$72 - $112	67%
Fl Community Care Ltc	$73	68%
Simply Healthcare Healthy Kids	$79	74%
Medicare (plans)	$100	94%
Hospice Covenant	$107	100%
Fl Blue	$178 - $1,676	167%
Uwf Athletes	$330	309%
Pensacola	$904	846%
Bc Fl	$1,043	977%
Wc Corvel	$1,786 - $5,724	1672%
Hospice Regency	$1,808	1693%
Cigna	$2,862 - $6,025	2680%
Hospice Emerald Coast	$3,012	2820%
Private Healthcare	$3,916	3666%
First Health	$4,187	3920%
Choicecare	$4,519	4231%
Multiplan	$5,362	5020%

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 $904.
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 Gulf Breeze 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.