CMS Price Transparency Data

CT scan, sinuses

Facility: Garnet Health Medical Center

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $297
Cash Discount Price: $217
vs. Medicare Baseline: 2.78x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Garnet Health Medical Center is $297. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $217. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.78x the Medicare baseline. Located in 707 East Main Street, Middletown, NY.

Cash / Self-Pay

$217

Average discount available for prompt cash payment at this facility.

Insurance Median

$297

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: $217 (203%)

Insurance Median: $297 (278%)

Cash: $217 (203% of Medicare)

Ins. Median: $297 (278% 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 278% of the Medicare baseline (a markup of 178%). 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	$130 - $368	122%
Fidelis	$133	125%
Wellcare	$134	125%
UnitedHealthcare	$171	160%
Rojw	$228	213%
Magnacare	$254 - $406	238%
Northwell Direct	$268	251%
Geisinger Health Plan	$326	305%
Mvp	$330	309%
Local 1199	$368	345%
Emblem Health	$470	440%
Blue Cross Blue Shield	$1,134 - $1,659	1062%

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 $217.
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 Garnet Health 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.