CMS Price Transparency Data

CT scan, head (with and without contrast)

Facility: Tomah Memorial Hospital

Billing Code: 70470 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70470
Insurance Median: $806
Cash Discount Price: $1,141
vs. Medicare Baseline: 4.50x Medicare

The contracted insurance negotiated median rate for a CT scan, head (with and without contrast) at Tomah Memorial Hospital is $806. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,141. Compared to the federal Medicare reimbursement reference rate of $179.2, this hospital’s rate is 4.50x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$1,141

Average discount available for prompt cash payment at this facility.

Insurance Median

$806

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: $1,141 (637%)

Insurance Median: $806 (450%)

Cash: $1,141 (637% of Medicare)

Ins. Median: $806 (450% 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 450% of the Medicare baseline (a markup of 350%). 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
UnitedHealthcare	$39 - $2,236	22%
Blue Cross Blue Shield	$56 - $2,182	31%
Group Hlth Mcr Adv - All Plans	$56 - $806	31%
Independent Care Mcr - All Other Plans	$56 - $806	31%
Quartz Mcr Adv	$56 - $806	31%
Security Hp Mcr Adv	$56 - $806	31%
Va Ccn - All Plans	$56 - $806	31%
Aetna	$65 - $2,016	36%
Security Hp Mcaid	$267 - $520	149%
The Alliance - All Plans	$287 - $14,109	160%
Independent Care Mcaid	$297 - $520	166%
Managed Hlth Mcaid - All Plans	$297 - $520	166%
Quartz Mcaid	$297 - $520	166%
Humana	$806 - $2,193	450%
Security Hp Comm - All Other Plans	$1,358 - $2,016	758%
Quartz Comm - All Other Plans	$1,438 - $2,134	802%
Cigna	$1,550 - $2,300	865%

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 $1,141.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70470.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Tomah Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 70470.
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.