CMS Price Transparency Data

CT scan, sinuses

Facility: Clarion Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $194
Cash Discount Price: $320
vs. Medicare Baseline: 1.82x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Clarion Hospital is $194. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $320. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.82x the Medicare baseline. Located in One Hospital Drive, Clarion, PA.

Cash / Self-Pay

$320

Average discount available for prompt cash payment at this facility.

Insurance Median

$194

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: $320 (300%)

Insurance Median: $194 (182%)

Cash: $320 (300% of Medicare)

Ins. Median: $194 (182% 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.

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
Highmark	$44 - $527	41%
Highmark - Ind.& Managed Care	$44 - $527	41%
Martin'S Point - Usfhp	$46 - $542	43%
Upmc	$46 - $775	43%
Gateway	$48 - $574	45%
Devoted Health Plan	$52 - $620	49%
Aetna	$65 - $1,380	61%
Cigna	$65 - $775	61%
Peak Health	$91 - $1,085	85%
Devon	$98 - $1,162	92%
Amerihealth	$102 - $143	95%
Highmark Community Blue	$102	95%
Medicare (plans)	$102	95%
Tricare	$102	95%
UnitedHealthcare	$102	95%
Geisinger	$107 - $156	100%
The Health Plan	$108 - $240	101%
Pa Health & Wellness	$109	102%
American Health Plan	$113	106%
Medicaid / KanCare	$130	122%
Jefferson Health Plan	$143	134%
Workers Comp	$562	526%

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 $320.
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 Clarion 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.