CMS Price Transparency Data

CT scan, sinuses

Facility: UPMC Kane

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $378
Cash Discount Price: $487
vs. Medicare Baseline: 3.54x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at UPMC Kane is $378. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $487. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.54x the Medicare baseline. Located in 4372 Route 6, Kane, PA.

Cash / Self-Pay

$487

Average discount available for prompt cash payment at this facility.

Insurance Median

$378

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: $487 (456%)

Insurance Median: $378 (354%)

Cash: $487 (456% of Medicare)

Ins. Median: $378 (354% 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 354% of the Medicare baseline (a markup of 254%). 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	$90 - $625	84%
Blue Cross Blue Shield	$95 - $506	89%
Highmark Wholecare (Prev Gateway)	$97 - $520	91%
Aetna	$99 - $526	93%
UnitedHealthcare	$99 - $701	93%
Amerihealth Caritas	$102 - $546	95%
Cigna	$179 - $30,774	168%
Horizon Health Plan	$179 - $957	168%
Geisinger	$181	169%
Multiplan	$192 - $1,025	180%
Health Coalition Partners	$205 - $1,094	192%
Intergroup	$205 - $1,094	192%
PA Health & Wellness	$222	208%
Focus Healthcare	$243 - $1,299	228%
UPMC Work Partners	$540	506%

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 $487.
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 Kane 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.