CMS Price Transparency Data

CT scan, sinuses

Facility: Margaretville Memorial Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $1,006
Cash Discount Price: $2,263
vs. Medicare Baseline: 9.42x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Margaretville Memorial Hospital is $1,006. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,263. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.42x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

$2,263

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,006

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: $2,263 (2119%)

Insurance Median: $1,006 (942%)

Cash: $2,263 (2119% of Medicare)

Ins. Median: $1,006 (942% 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 942% of the Medicare baseline (a markup of 842%). 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
Oxford	$179	168%
UnitedHealthcare	$179 - $996	168%
Aetna	$276 - $2,263	258%
Mvp	$381	357%
Emblem	$394 - $463	369%
Mvp Hmo/Ppo	$449	420%
Mvp Gold (McR)	$996	932%
Medicare (plans)	$996 - $1,494	932%
Hamaspik (McR)	$996	932%
Blue Cross Blue Shield	$996 - $1,381	932%
Affinity By Molina McR	$1,046	979%
Cdphp	$1,095	1025%
Emblem Ghi/Hip Ppo/Cbp	$1,403	1314%
Mvp Exchange	$1,471	1377%
Self-Pay	$1,490	1395%
Emblem Select Care (Exchange)	$1,539	1441%
Oxford Exchange	$1,584	1483%
Magnacare Standard	$1,584	1483%
Todays Options	$1,643	1538%
Emblem Ghi/Hip Hmo/Epo/Pos	$1,810	1695%
Magnacare Preferred	$1,810	1695%
Multiplan	$1,856	1738%
First Health	$2,037	1907%

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 $2,263.
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 Margaretville 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.