CMS Price Transparency Data

CT scan, sinuses

Facility: Nemours Childrens Hospital, Florida

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $1,530
Cash Discount Price: $3,825
vs. Medicare Baseline: 14.32x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Nemours Childrens Hospital, Florida is $1,530. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,825. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 14.32x the Medicare baseline. Located in 6535 Nemours Pkwy, Orlando, FL.

Cash / Self-Pay

$3,825

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,530

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: $3,825 (3581%)

Insurance Median: $1,530 (1432%)

Cash: $3,825 (3581% of Medicare)

Ins. Median: $1,530 (1432% 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 1432% of the Medicare baseline (a markup of 1332%). 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
Tricare	$107	100%
Truli	$583 - $1,530	546%
Aetna	$630	590%
Florida Blue	$648 - $2,333	607%
Avmed	$795	744%
Evolutions Healthcare	$927	868%
UnitedHealthcare	$1,426	1335%
Cigna	$1,443	1351%
Employers Health Network Fl	$1,530	1432%
Integra Administrative Group	$2,295	2149%
Global Medical Management	$2,486	2327%
Prime Health Services	$2,486	2327%
Star Healthcare Network	$2,486	2327%
Velocity	$2,869	2686%
First Health Network	$2,984	2794%
Pnoa	$3,060	2865%
Seminole Tribe Of Fl	$3,060	2865%
Private Healthcare Systems	$3,519	3295%

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 $3,825.
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 Nemours Childrens Hospital, Florida 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.