CMS Price Transparency Data

CT scan, sinuses

Facility: UPMC Mercy

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $1,154
Cash Discount Price: $1,950
vs. Medicare Baseline: 10.80x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at UPMC Mercy is $1,154. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,950. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.80x the Medicare baseline. Located in 1400 Locust Street, Pittsburgh, PA.

Cash / Self-Pay

$1,950

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,154

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: $1,950 (1826%)

Insurance Median: $1,154 (1080%)

Cash: $1,950 (1826% of Medicare)

Ins. Median: $1,154 (1080% 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 1080% of the Medicare baseline (a markup of 980%). 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
Upmc Health Plan	$85 - $849	80%
Aetna	$106 - $1,300	99%
Amerihealth Caritas	$109 - $206	102%
Highmark Wholecare (Prev Gateway)	$109 - $193	102%
Pa Health & Wellness	$109 - $222	102%
UnitedHealthcare	$150	140%
Blue Cross Blue Shield	$272 - $1,545	255%
Upmc Work Partners	$600	562%
Bravo	$812	760%
Cigna	$1,105 - $1,950	1035%
Coventry/First Health	$1,430	1339%
Intergroup	$1,625 - $2,600	1521%
Private Health Care Systems	$2,438	2283%
American Healthcare Group	$2,600	2434%
National Provider Network	$2,665	2495%
Health Payors Organization	$2,925	2739%
Multiplan	$2,925	2739%

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 $1,950.
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 UPMC Mercy 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.