CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Fort Memorial Hospital

Billing Code: 70553 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$279

about 0.8× the $356 Medicare rate · typically $267–$400

modeled estimate · not a bill or quote

What this hospital charges insurers

$272

About the fair price

about $7 under the fair price · 0.8× Medicare

Medicare pays $356 Fair price $279 This hospital $272 Cash price $1,628 Hospital's list price $5,086

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

A typical price — 5 charge more and 3 charge less, among the 9 WI hospitals compared.

Cheapest $117 Priciest $345

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a MRI, brain (with and without contrast) is about $279 (about 0.8× the $356 Medicare rate). Fort Memorial Hospital charges insurers about $272, or about $1,628 in cash — about the fair price. Located in Fort Atkinson, WI.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$101 - $390	28%
Blue Cross Blue Shieldmajor	$101 - $1,434	28%
Aetnamajor	$253 - $5,284	71%
Cignamajor	$776 - $6,694	218%
Humanamajor	$101 - $582	28%
Dean Health Plan	$101 - $3,116	28%
Molina	$101 - $344	28%
Quartz	$101 - $3,203	28%
+ 8 smaller / regional plans	$97 - $6,195

Government programs also on file: Medicare, Medicaid.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 1,628), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 70553.

Insurance Before you use insurance

Call your insurance company to confirm Fort Memorial Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 70553.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Fort Memorial Hospital

Compare: MRI, brain (with and without contrast) at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.