CMS Price Transparency Data

CT scan, sinuses

Facility: Fort Memorial Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $102
Cash Discount Price: $430
vs. Medicare Baseline: 0.95x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Fort Memorial Hospital is $102. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $430. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.95x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$430

Average discount available for prompt cash payment at this facility.

Insurance Median

$102

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: $430 (403%)

Insurance Median: $102 (95%)

Cash: $430 (403% of Medicare)

Ins. Median: $102 (95% 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
Mercycare	$37 - $1,724	35%
Blue Cross Blue Shield	$38 - $955	36%
Dean Health Plan	$38 - $800	36%
Humana	$38 - $247	36%
Molina	$38 - $128	36%
Quartz	$38 - $1,289	36%
UnitedHealthcare	$38 - $149	36%
Medicaid / KanCare	$44	41%
Managed Health Services	$48 - $63	45%
Aetna	$79 - $1,736	74%
Medicare (plans)	$102	95%
Alliance	$105 - $1,661	98%
Veteran Evaluation Services	$127	119%
Fort Care	$128 - $412	120%
Centivo	$168 - $1,050	157%
Group Health Cooperative	$210 - $1,498	197%
Trilogy	$304 - $2,036	285%
Cigna	$329 - $2,200	308%

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 $430.
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 Fort Memorial Hospital 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.