CMS Price Transparency Data

CT scan, sinuses

Facility: Caribbean Medical Center

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $94
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.88x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Caribbean Medical Center is $94. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.88x the Medicare baseline. Located in 151 Ave Osvaldo Molina, Fajardo, PR.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$94

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%)

Insurance Median: $94 (88%)

Ins. Median: $94 (88% 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
Menonita Ases	$34 - $110	32%
Humana	$39 - $90	37%
Medicare (plans)	$39 - $99	37%
Mmm	$39 - $83	37%
Tricare	$39 - $99	37%
Veteran Administration	$39 - $68	37%
Champva	$41 - $99	38%
First Medical Ases	$41 - $94	38%
Mmm Multi Health Ases	$41 - $94	38%
Triples S Reforma	$41 - $116	38%
Health First	$42	39%
UnitedHealthcare	$42	39%
Well Care	$42 - $99	39%
Tsa	$44 - $99	41%
Hoffa	$105	98%
Mcs Classicare	$105	98%
Mcs Privado	$112	105%
Asociacion De Maestros Pr	$130 - $260	122%
Mapfre	$130 - $150	122%
Imc Privado	$138	129%
Triple S Privado	$138	129%
Union Carpinteros	$138	129%
Cfse	$143	134%
Menonita Privado	$150 - $300	140%
Panamerican Life Insurance	$150	140%
Acaa	$164	154%
Auxilio Mutuo	$275	257%
Auxilio Mutuo Plus	$275	257%

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 $X.
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 Caribbean 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.