CMS Price Transparency Data

CT scan, head (with contrast)

Facility: Gundersen St Josephs Hospital and Clinics

Billing Code: 70460 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70460
Insurance Median: $1,862
Cash Discount Price: $1,529
vs. Medicare Baseline: 10.39x Medicare

The contracted insurance negotiated median rate for a CT scan, head (with contrast) at Gundersen St Josephs Hospital and Clinics is $1,862. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,529. Compared to the federal Medicare reimbursement reference rate of $179.2, this hospital’s rate is 10.39x the Medicare baseline. Located in 400 Water Ave, Hillsboro, WI.

Cash / Self-Pay

$1,529

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,862

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: $1,529 (853%)

Insurance Median: $1,862 (1039%)

Cash: $1,529 (853% of Medicare)

Ins. Median: $1,862 (1039% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1039% of the Medicare baseline (a markup of 939%). 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
Amerigroup	$138	77%
Security Health Plan	$517	289%
Blue Cross Blue Shield	$851 - $2,313	475%
Iowa Total Care	$851	475%
Managed Health Service	$851	475%
Ucare	$1,369 - $2,106	764%
UnitedHealthcare	$1,395 - $1,840	778%
Quartz	$1,434	800%
Alliance	$2,102 - $3,091	1173%
Cigna	$2,158	1204%
Aspirus Arise Health	$2,185	1219%
Humana	$2,237	1248%
Multiplan/Healtheos	$2,290 - $2,500	1278%
Coventry Health Care	$2,500	1395%

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 $1,529.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70460.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Gundersen St Josephs Hospital and Clinics is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 70460.
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.