CMS Price Transparency Data

CT scan, sinuses

Facility: Ocean Medical Center

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $463
Cash Discount Price: $111
vs. Medicare Baseline: 4.33x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Ocean Medical Center is $463. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.33x the Medicare baseline. Located in 425 Jack Martin Blvd, Brick, NJ.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$463

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: $111 (104%)

Insurance Median: $463 (433%)

Cash: $111 (104% of Medicare)

Ins. Median: $463 (433% 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 433% of the Medicare baseline (a markup of 333%). 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
Karna	$71 - $253	66%
Aetna	$106 - $1,935	99%
Amerigroup	$106	99%
Horizon	$106 - $1,998	99%
Vaccn	$106 - $116	99%
Wellcare	$106 - $116	99%
United Community/Americhoice	$112 - $122	105%
Blue Cross Blue Shield	$116	109%
UnitedHealthcare	$139 - $714	130%
Oxford	$265	248%
Cigna	$271 - $278	254%
Clover	$436	408%
Amerihealth	$463 - $471	433%
Seoul Medical Group	$469 - $495	439%
Activecare First McO	$650 - $1,612	609%
Intergroup	$1,612	1509%
Brighton Health Plan	$1,670	1564%
Qualcare	$1,762 - $2,159	1650%
Bergen Risk	$1,815	1699%
Prime Health	$1,842	1725%
Multiplan - PHCS	$1,958 - $2,057	1833%

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 $111.
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 Ocean Medical Center 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.