CMS Price Transparency Data

Blood test, complete blood count (CBC)

Facility: Tomah Memorial Hospital

Billing Code: 85025 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 85025
  • Insurance Median: $67
  • Cash Discount Price: $113
  • vs. Medicare Baseline: 8.62x Medicare
The contracted insurance negotiated median rate for a Blood test, complete blood count (CBC) at Tomah Memorial Hospital is $67. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $113. Compared to the federal Medicare reimbursement reference rate of $7.77, this hospital’s rate is 8.62x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.
Cash / Self-Pay
$113

Average discount available for prompt cash payment at this facility.

Insurance Median
$67

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$7.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $7.77 (100%)
Cash / Self-Pay: $113 (1454%)
Insurance Median: $67 (862%)
Cash: $113 (1454% of Medicare)
Ins. Median: $67 (862% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $7.77 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 862% of the Medicare baseline (a markup of 762%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 $8 - $181 103%
Independent Care Mcaid $8 103%
Managed Hlth Mcaid - All Plans $8 103%
Quartz Mcaid $8 103%
Security Hp Mcaid $8 103%
Va Ccn - All Plans $15 193%
Group Hlth Mcr Adv - All Plans $67 862%
Humana $67 - $182 862%
Independent Care Mcr - All Other Plans $67 862%
Quartz Mcr Adv $67 862%
Security Hp Mcr Adv $67 862%
UnitedHealthcare $67 - $185 862%
Aetna $128 - $167 1647%
Cigna $149 - $190 1918%
Security Hp Comm - All Other Plans $167 2149%
Quartz Comm - All Other Plans $177 2278%
The Alliance - All Plans $183 2355%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 501 Gopher Dr, Tomah, WI 54660
  • CMS Rating: ★★★★★
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals