CMS Price Transparency Data

CT scan, sinuses

Facility: UPMC Hamot

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $610
Cash Discount Price: $1,465
vs. Medicare Baseline: 5.71x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at UPMC Hamot is $610. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,465. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.71x the Medicare baseline. Located in 201 State Street, Erie, PA.

Cash / Self-Pay

$1,465

Average discount available for prompt cash payment at this facility.

Insurance Median

$610

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: $1,465 (1372%)

Insurance Median: $610 (571%)

Cash: $1,465 (1372% of Medicare)

Ins. Median: $610 (571% 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 571% of the Medicare baseline (a markup of 471%). 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	$99 - $1,313	93%
Fidelis	$117	110%
Aetna	$119 - $1,709	111%
Upmc Health Plan	$119 - $424	111%
Wellcare	$121	113%
UnitedHealthcare	$125 - $693	117%
Amerihealth Caritas	$126 - $203	118%
Cigna	$126 - $976	118%
Highmark Wholecare (Prev Gateway)	$126 - $1,220	118%
Pa Health & Wellness	$126 - $222	118%
Independent Health	$166 - $222	155%
Geisinger	$181	169%
Health Partners Plans (Jefferson Health Plan)	$196	184%
Univera	$366 - $1,074	343%
Upmc Work Partners	$590	552%
Intergroup	$1,587 - $1,953	1486%
Multiplan	$1,709 - $1,953	1600%

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 $1,465.
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 Hamot 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.