CMS Price Transparency Data

CT scan, sinuses

Facility: Penobscot Valley Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $862
Cash Discount Price: $1,467
vs. Medicare Baseline: 8.07x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Penobscot Valley Hospital is $862. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,467. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.07x the Medicare baseline. Located in 7 Transalpine Road, Po Box 368, Lincoln, ME.

Cash / Self-Pay

$1,467

Average discount available for prompt cash payment at this facility.

Insurance Median

$862

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: $1,467 (1373%)

Insurance Median: $862 (807%)

Cash: $1,467 (1373% of Medicare)

Ins. Median: $862 (807% 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 807% of the Medicare baseline (a markup of 707%). 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
Medicare (plans)	$117 - $844	110%
UnitedHealthcare	$844 - $1,467	790%
Humana	$853	799%
Wellcare Health Plan Inc Mcr Adv	$853	799%
Aetna	$862 - $1,760	807%
Blue Cross Blue Shield	$870 - $1,359	815%
Cigna	$1,723	1613%
Harvard Pilgrim Healthcare	$1,751	1639%

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 $1,467.
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 Penobscot Valley 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.