CT head without contrast at Gundersen TriCounty Hospital and Clinics. CPT 70450.
What Gundersen TriCounty Hospital and Clinics publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$876cash price (self-pay)
$1,382list price
$144–$2,570range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup | Medicaid HMO | $144 |
| Quartz | All Products | $585 |
| Quartz | All Other Self Funded | $608 |
| Quartz | Self Funded | $650 |
| Quartz | Level Funded | $670 |
| Anthem | Medicaid | $709 |
| Group Health Eau Claire | Medicaid HMO | $709 |
| Group Health of South Central | Medicaid HMO | $709 |
| Iowa Total Care | Medicaid | $709 |
| Managed Health Service | Managed Medicaid | $709 |
| Quartz | Medicaid_Badgercare | $709 |
| UCARE | Non-Dually Eligible | $719 |
| UCARE | MSHO/Minnesota Special Needs | $719 |
| UCARE | Dually Eligible | $719 |
| Quartz | Fully Insured | $753 |
| Anthem | Medicare HMO/PPO | $815 |
| Humana | Medicare Advantage | $815 |
| Quartz | Medicare Advantage | $815 |
| UHC | Medicare Advantage | $815 |
| UHC | All Payer Appendix | $995 |
| Cigna | All Products | $1,066 |
| Alliance | Premier/All Products | $1,106 |
| Group Health of South Central | All Products | $1,106 |
| Trilogy | All Products | $1,106 |
| UCARE | Qualified Health Plan | $1,106 |
| Aspirus Arise Health | All Products | $1,147 |
| Allied National | Core Value Programs | $1,175 |
| Sana | All Products | $1,189 |
| Group Health Eau Claire | All Products | $1,244 |
| Alliance | Comprehensive/All Products | $1,313 |
Inpatient
$876cash price (self-pay)
$1,382list price
$585–$1,313range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Other Self Funded | $814 |
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All common services at Gundersen TriCounty Hospital and Clinics