CMS Price Transparency Data

CT scan, sinuses

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $2,436
Cash Discount Price: $3,110
vs. Medicare Baseline: 22.81x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at UPMC Children's Hospital of Pittsburgh is $2,436. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,110. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 22.81x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$3,110

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,436

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: $3,110 (2912%)

Insurance Median: $2,436 (2281%)

Cash: $3,110 (2912% of Medicare)

Ins. Median: $2,436 (2281% 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 2281% of the Medicare baseline (a markup of 2181%). 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
Health Plan Of Upper Ohio Valley	$101 - $3,369	95%
Blue Cross Blue Shield	$108 - $2,592	101%
Amerihealth Caritas	$109 - $487	102%
Cigna	$109 - $2,851	102%
Aetna	$112 - $2,851	105%
Upmc Health Plan	$300 - $1,054	281%
UnitedHealthcare	$308 - $2,436	288%
Health Partners Plans (Jefferson Health Plan)	$503	471%
Highmark Wholecare (Prev Gateway)	$525	492%
Pa Health & Wellness	$527	493%
Geisinger	$534 - $2,330	500%
Intergroup	$3,369 - $4,406	3154%
Coventry/First Health	$4,146	3882%
Saudi Armed Forces	$4,146	3882%
Health Payors Organization	$4,406	4125%
Multiplan	$4,406	4125%
National Provider Network	$4,665	4368%
Private Health Care Systems	$4,665	4368%

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 $3,110.
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 Children's Hospital of Pittsburgh 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.