CMS Price Transparency Data

CT scan, sinuses

Facility: UPMC Carlisle

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $522
Cash Discount Price: $797
vs. Medicare Baseline: 4.89x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at UPMC Carlisle is $522. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $797. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.89x the Medicare baseline. Located in 361 Alexander Spring Road, Carlisle, PA.

Cash / Self-Pay

$797

Average discount available for prompt cash payment at this facility.

Insurance Median

$522

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: $797 (746%)

Insurance Median: $522 (489%)

Cash: $797 (746% of Medicare)

Ins. Median: $522 (489% 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 489% of the Medicare baseline (a markup of 389%). 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	$101 - $726	95%
Humana	$102	95%
UnitedHealthcare	$102 - $977	95%
Aetna	$106 - $649	99%
Cigna	$107 - $589	100%
Geisinger	$107 - $959	100%
Pa Health & Wellness	$110 - $222	103%
Keystone Autism Services	$163	153%
Amerihealth Caritas	$165	154%
Highmark Wholecare (Prev Gateway)	$165	154%
Upmc Health Plan	$169 - $930	158%
Health Partners Plans (Jefferson Health Plan)	$177	166%
Prime Net	$182 - $1,004	170%
Onecall	$250	234%
Keystone Health Plan	$266 - $726	249%
Premier Comp Solutions	$280	262%
Upmc Work Partners	$565	529%
Wellspan Population Health	$863 - $1,062	808%
Multiplan	$1,129	1057%

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 $797.
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 Carlisle 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.