CMS Price Transparency Data

CT scan, sinuses

Facility: Southwestern Vermont Medical Center

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $104
Cash Discount Price: $933
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Southwestern Vermont Medical Center is $104. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $933. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.97x the Medicare baseline. Located in 100 Hospital Drive, Bennington, VT.

Cash / Self-Pay

$933

Average discount available for prompt cash payment at this facility.

Insurance Median

$104

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: $933 (874%)

Insurance Median: $104 (97%)

Cash: $933 (874% of Medicare)

Ins. Median: $104 (97% 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
Cdphp	$27 - $197	25%
Aetna	$38 - $347	36%
Blue Cross Blue Shield	$38 - $109	36%
Cigna	$38 - $193	36%
Fidelis	$38 - $114	36%
Hne	$38 - $111	36%
Humana	$38 - $109	36%
Mvp	$38 - $195	36%
UnitedHealthcare	$38 - $109	36%
Wellcare	$38 - $109	36%
Health New England	$44	41%
Allegiance	$53	50%
Bmc	$111	104%
Tufts	$380	356%

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 $933.
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 Southwestern Vermont Medical Center 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.