CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Fort Memorial Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $341
Cash Discount Price: $1,628
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Fort Memorial Hospital is $341. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,628. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 0.96x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$1,628

Average discount available for prompt cash payment at this facility.

Insurance Median

$341

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)

Cash / Self-Pay: $1,628 (457%)

Insurance Median: $341 (96%)

Cash: $1,628 (457% of Medicare)

Ins. Median: $341 (96% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 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	$97 - $5,245	27%
Blue Cross Blue Shield	$101 - $1,434	28%
Dean Health Plan	$101 - $3,116	28%
Humana	$101 - $582	28%
Molina	$101 - $344	28%
Quartz	$101 - $3,203	28%
UnitedHealthcare	$101 - $390	28%
Managed Health Services	$131 - $182	37%
Medicaid / KanCare	$167	47%
Aetna	$253 - $5,284	71%
Alliance	$279 - $5,056	78%
Fort Care	$341 - $1,078	96%
Medicare (plans)	$344	97%
Centivo	$396 - $1,000	111%
Group Health Cooperative	$417 - $4,557	117%
Veteran Evaluation Services	$445	125%
Trilogy	$718 - $6,195	201%
Cigna	$776 - $6,694	218%

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 $1,628.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70553.

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 70553.
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.