CMS Price Transparency Data

CT scan, head (with and without contrast)

Facility: UPMC Somerset

Billing Code: 70470 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70470
Insurance Median: $863
Cash Discount Price: $1,298
vs. Medicare Baseline: 4.82x Medicare

The contracted insurance negotiated median rate for a CT scan, head (with and without contrast) at UPMC Somerset is $863. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,298. Compared to the federal Medicare reimbursement reference rate of $179.2, this hospital’s rate is 4.82x the Medicare baseline. Located in 225 South Center Avenue, Somerset, PA.

Cash / Self-Pay

$1,298

Average discount available for prompt cash payment at this facility.

Insurance Median

$863

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$179.2

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $179.2 (100%)

Cash / Self-Pay: $1,298 (724%)

Insurance Median: $863 (482%)

Cash: $1,298 (724% of Medicare)

Ins. Median: $863 (482% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $179.2 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 482% of the Medicare baseline (a markup of 382%). 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
UnitedHealthcare	$115 - $934	64%
Blue Cross Blue Shield	$168 - $376	94%
Amerihealth Caritas	$170 - $183	95%
Upmc Health Plan	$170 - $1,191	95%
Highmark Wholecare (Prev Gateway)	$183 - $204	102%
Geisinger	$221 - $853	123%
Upmc Work Partners	$752	420%
Aetna	$863 - $867	482%
Multiplan	$1,079 - $1,409	602%
Galaxy Health Plan	$1,403 - $1,409	783%
Humana	$1,618 - $1,625	903%

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 $1,298.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70470.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UPMC Somerset is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 70470.
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.