CMS Price Transparency Data

CT scan, head (with contrast)

Facility: St Josephs Community Hospital West Bend

Billing Code: 70460 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70460
Insurance Median: $1,678
Cash Discount Price: $1,466
vs. Medicare Baseline: 9.36x Medicare

The contracted insurance negotiated median rate for a CT scan, head (with contrast) at St Josephs Community Hospital West Bend is $1,678. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,466. Compared to the federal Medicare reimbursement reference rate of $179.2, this hospital’s rate is 9.36x the Medicare baseline. Located in 3200 Pleasant Valley Road, West Bend, WI.

Cash / Self-Pay

$1,466

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,678

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$179.2

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $179.2 (100%)

Cash / Self-Pay: $1,466 (818%)

Insurance Median: $1,678 (936%)

Cash: $1,466 (818% of Medicare)

Ins. Median: $1,678 (936% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $179.2 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 936% of the Medicare baseline (a markup of 836%). 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
Blue Cross Blue Shield	$168 - $2,265	94%
Allwell	$173	97%
Community Care	$173	97%
Health Partners	$173 - $1,732	97%
Humana	$173	97%
Icare	$173	97%
Molina	$173	97%
Network Health Plan	$173 - $1,033	97%
Security Health Plan Secure Savers	$173	97%
UnitedHealthcare	$173 - $1,565	97%
Aetna	$176 - $1,866	98%
Care Wisconsin	$178	99%
Centivo	$800 - $879	446%
Froedtert South	$1,119	624%
Chorus Community Health Plan	$1,146	640%
Common Ground	$1,599	892%
Health Payment Systems	$1,678 - $2,154	936%
Sheboygan Employers Health Network	$1,791	999%
Wisconsin Physician Services	$2,132	1190%
Trilogy	$2,185	1219%
Americas Choice	$2,319	1294%
Healtheos	$2,319	1294%
Multiplan/Private Healthcare Systems	$2,319	1294%
First Health Network	$2,345	1309%
Hfn	$2,398	1338%
Ibsi Passport	$2,398	1338%
Cigna	$2,532	1413%
Healthsmart	$2,532	1413%

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 $1,466.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70460.

Insurance In-Network Protection Plan

Contact your insurance company to confirm St Josephs Community Hospital West Bend is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 70460.
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.