CMS Price Transparency Data

CT scan, sinuses

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $110
Cash Discount Price: $1,251
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Munson Healthcare Otsego Memorial Hospital is $110. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,251. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.03x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.

Cash / Self-Pay

$1,251

Average discount available for prompt cash payment at this facility.

Insurance Median

$110

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: $1,251 (1171%)

Insurance Median: $110 (103%)

Cash: $1,251 (1171% of Medicare)

Ins. Median: $110 (103% 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.

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
Blue Cross Blue Shield	$26 - $919	24%
Mclaren Health Plan	$26 - $1,234	24%
Meridian	$26 - $54	24%
Molina	$26 - $130	24%
Priority Health	$26 - $311	24%
UnitedHealthcare	$26 - $1,179	24%
Aetna	$39 - $1,192	37%
Blue Care Network	$39 - $120	37%
Hap (Health Alliance Plan)	$39 - $1,178	37%
Humana	$39 - $120	37%
Medicare (plans)	$39 - $120	37%
Michigan Amish Medical Board	$39 - $120	37%
Northern Michigan Mennonite Group	$39 - $120	37%
Asr Physicians Care Network	$59 - $1,178	55%
Cigna	$61 - $311	57%
Nomi Health	$62 - $1,178	58%
Employee Benefit Logistics	$66 - $204	62%
Munson Hospice	$852 - $1,030	798%
Hospice Of Michigan	$883	827%
Enterprise Group Planning/Employee Benefit Plan	$1,178	1103%
Cofinity	$1,251	1171%
Provider Network Of America/Hawaii Mainland Administrative Group Health	$1,251	1171%
Three Rivers Provider Network	$1,251	1171%

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 $1,251.
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 Munson Healthcare Otsego Memorial 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.