CMS Price Transparency Data

CT scan, sinuses

Facility: Froedtert Community Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $1,136
Cash Discount Price: $1,266
vs. Medicare Baseline: 10.64x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Froedtert Community Hospital is $1,136. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,266. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.64x the Medicare baseline. Located in 4805 S Moorland Rd, New Berlin, WI.

Cash / Self-Pay

$1,266

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,136

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: $1,266 (1185%)

Insurance Median: $1,136 (1064%)

Cash: $1,266 (1185% of Medicare)

Ins. Median: $1,136 (1064% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1064% of the Medicare baseline (a markup of 964%). 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	$103 - $1,362	96%
Care Wisconsin	$103	96%
Community Care	$103	96%
Health Partners	$103 - $1,496	96%
Humana	$103	96%
Icare	$103	96%
Molina	$103	96%
Network Health Plan	$103 - $827	96%
Security Health Plan Secure Savers	$103	96%
UnitedHealthcare	$103 - $1,136	96%
Chorus Community Health Plan	$920	861%
Medical College Of Wisconsin	$920	861%
Centivo	$989 - $1,150	926%
Cigna	$1,351	1265%
Common Ground	$1,381	1293%
Sheboygan Employers Health Network	$1,381	1293%
Wisconsin Physician Services	$1,381	1293%
Health Payment Systems	$1,406	1316%
Trilogy	$1,496	1401%
Americas Choice	$2,002	1874%
Healtheos	$2,002	1874%
Multiplan/Private Healthcare Systems	$2,002	1874%
First Health Network	$2,025	1896%

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 $1,266.
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 Froedtert Community 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.