CMS Price Transparency Data

Blood test, liver function panel

Facility: Tomah Memorial Hospital

Billing Code: 80076 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80076
Insurance Median: $91
Cash Discount Price: $154
vs. Medicare Baseline: 11.14x Medicare

The contracted insurance negotiated median rate for a Blood test, liver function panel at Tomah Memorial Hospital is $91. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $154. Compared to the federal Medicare reimbursement reference rate of $8.17, this hospital’s rate is 11.14x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$154

Average discount available for prompt cash payment at this facility.

Insurance Median

$91

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$8.17

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $8.17 (100%)

Cash / Self-Pay: $154 (1885%)

Insurance Median: $91 (1114%)

Cash: $154 (1885% of Medicare)

Ins. Median: $91 (1114% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $8.17 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 1114% of the Medicare baseline (a markup of 1014%). 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 - $246	135%
Independent Care Mcaid	$11	135%
Managed Hlth Mcaid - All Plans	$11	135%
Quartz Mcaid	$11	135%
Security Hp Mcaid	$11	135%
Va Ccn - All Plans	$22	269%
Group Hlth Mcr Adv - All Plans	$91	1114%
Humana	$91 - $248	1114%
Independent Care Mcr - All Other Plans	$91	1114%
Quartz Mcr Adv	$91	1114%
Security Hp Mcr Adv	$91	1114%
UnitedHealthcare	$91 - $252	1114%
Aetna	$174 - $228	2130%
Cigna	$203 - $260	2485%
Security Hp Comm - All Other Plans	$228	2791%
Quartz Comm - All Other Plans	$241	2950%
The Alliance - All Plans	$249	3048%

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 $154.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 80076.

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 80076.
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.