CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Tomah Memorial Hospital

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $116
Cash Discount Price: $196
vs. Medicare Baseline: 10.98x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Tomah Memorial Hospital is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $196. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 10.98x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$196

Average discount available for prompt cash payment at this facility.

Insurance Median

$116

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.56 (100%)

Cash / Self-Pay: $196 (1856%)

Insurance Median: $116 (1098%)

Cash: $196 (1856% of Medicare)

Ins. Median: $116 (1098% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.56 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 1098% of the Medicare baseline (a markup of 998%). 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	$11 - $314	104%
Independent Care Mcaid	$11	104%
Managed Hlth Mcaid - All Plans	$11	104%
Quartz Mcaid	$11	104%
Security Hp Mcaid	$11	104%
Va Ccn - All Plans	$36	341%
Group Hlth Mcr Adv - All Plans	$116	1098%
Humana	$116 - $316	1098%
Independent Care Mcr - All Other Plans	$116	1098%
Quartz Mcr Adv	$116	1098%
Security Hp Mcr Adv	$116	1098%
UnitedHealthcare	$116 - $322	1098%
Aetna	$222 - $290	2102%
Cigna	$260 - $331	2462%
Security Hp Comm - All Other Plans	$290	2746%
Quartz Comm - All Other Plans	$307	2907%
The Alliance - All Plans	$318	3011%

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 $196.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 80053.

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 80053.
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.