CMS Price Transparency Data

CT scan, head (with and without contrast)

Facility: Fort Memorial Hospital

Billing Code: 70470 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70470
Insurance Median: $172
Cash Discount Price: $586
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a CT scan, head (with and without contrast) at Fort Memorial Hospital is $172. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $586. Compared to the federal Medicare reimbursement reference rate of $179.2, this hospital’s rate is 0.96x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$586

Average discount available for prompt cash payment at this facility.

Insurance Median

$172

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: $586 (327%)

Insurance Median: $172 (96%)

Cash: $586 (327% of Medicare)

Ins. Median: $172 (96% 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.

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	$49 - $955	27%
Mercycare	$54 - $2,401	30%
Dean Health Plan	$56 - $1,773	31%
Humana	$56 - $283	31%
Molina	$56 - $174	31%
Quartz	$56 - $1,744	31%
UnitedHealthcare	$56 - $204	31%
Managed Health Services	$62 - $145	35%
Aetna	$117 - $2,418	65%
Medicaid / KanCare	$133	74%
Alliance	$156 - $2,314	87%
Medicare (plans)	$172	96%
Fort Care	$189 - $565	105%
Centivo	$192 - $1,050	107%
Veteran Evaluation Services	$213	119%
Group Health Cooperative	$241 - $2,086	134%
Trilogy	$349 - $2,835	195%
Cigna	$377 - $3,063	210%

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 $586.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70470.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Fort Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 70470.
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.