CMS Price Transparency Data

CT scan, sinuses

Facility: Children's Hospital of Philadelphia

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $1,823
Cash Discount Price: $5,224
vs. Medicare Baseline: 17.07x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Children's Hospital of Philadelphia is $1,823. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,224. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 17.07x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$5,224

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,823

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: $5,224 (4891%)

Insurance Median: $1,823 (1707%)

Cash: $5,224 (4891% of Medicare)

Ins. Median: $1,823 (1707% 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 1707% of the Medicare baseline (a markup of 1607%). 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
Geisinger Medical Assistance	$105	98%
Highmark Wholecare	$116	109%
Horizon Nj Health	$496	464%
Medicaid / KanCare	$862	807%
UnitedHealthcare	$867 - $1,299	812%
Health Partners	$985	922%
Aetna	$1,375 - $2,612	1287%
Upmc Medical Assistance	$1,426	1335%
Keystone First Chip	$1,619	1516%
Keystone Health Plan East	$1,652	1547%
Geisinger Health Plan Commercial	$1,802	1687%
Blue Cross Blue Shield	$1,844 - $2,093	1726%
Jefferson Health Plans	$2,471	2313%
Cigna	$2,612	2445%
Highmark	$2,612	2445%
Qualcare	$2,873	2690%
First Health Network	$3,395	3179%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$4,179	3913%
Private Health Care Systems	$4,179	3913%
Choice Care Network	$4,701	4401%

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 $5,224.
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 Children's Hospital of Philadelphia 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.