CMS Price Transparency Data

CT scan, sinuses

Facility: Down East Community Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $807
Cash Discount Price: $1,005
vs. Medicare Baseline: 7.56x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Down East Community Hospital is $807. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,005. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.56x the Medicare baseline. Located in 11 Hospital Drive, Machias, ME.

Cash / Self-Pay

$1,005

Average discount available for prompt cash payment at this facility.

Insurance Median

$807

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: $1,005 (941%)

Insurance Median: $807 (756%)

Cash: $1,005 (941% of Medicare)

Ins. Median: $807 (756% 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 756% of the Medicare baseline (a markup of 656%). 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
Blue Cross Blue Shield	$172 - $1,539	161%
Humana	$172 - $839	161%
Wellcare	$172 - $839	161%
Partners Direct Health	$196 - $954	184%
Community Health Options	$324 - $1,579	303%
Aetna	$326 - $1,592	305%
UnitedHealthcare	$336 - $1,640	315%
Martins Point	$352 - $1,716	330%
Patients Advocates	$352 - $1,716	330%
Cigna	$353 - $1,720	330%
Harvard Pilgrim	$358 - $1,745	335%

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 $1,005.
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 Down East Community 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.