CMS Price Transparency Data

CT scan, sinuses

Facility: Avita Ontario

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $607
Cash Discount Price: $2,493
vs. Medicare Baseline: 5.68x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Avita Ontario is $607. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,493. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.68x the Medicare baseline. Located in 715 Richland Mall, Ontario, OH.

Cash / Self-Pay

$2,493

Average discount available for prompt cash payment at this facility.

Insurance Median

$607

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: $2,493 (2334%)

Insurance Median: $607 (568%)

Cash: $2,493 (2334% of Medicare)

Ins. Median: $607 (568% 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 568% of the Medicare baseline (a markup of 468%). 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
Medical_Mutual	$48 - $3,588	45%
Caresource	$310	290%
Medicaid / KanCare	$310	290%
Molina	$310 - $5,629	290%
Ohiorise	$310	290%
United_Healthcare	$310 - $2,493	290%
Blue Cross Blue Shield	$319 - $3,518	299%
Amerihealth	$325	304%
Buckeye	$335 - $3,518	314%
Humana	$335 - $3,518	314%
Aetna	$601 - $3,588	563%
Medicare (plans)	$601 - $3,518	563%
Mount_Carmel	$601 - $3,518	563%
Cigna	$2,285	2139%

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 $2,493.
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 Avita Ontario 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.