CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Tomah Memorial Hospital

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74176
Insurance Median: $1,356
Cash Discount Price: $1,713
vs. Medicare Baseline: 5.56x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Tomah Memorial Hospital is $1,356. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,713. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 5.56x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$1,713

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,356

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $1,713 (703%)

Insurance Median: $1,356 (556%)

Cash: $1,713 (703% of Medicare)

Ins. Median: $1,356 (556% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 556% of the Medicare baseline (a markup of 456%). 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	$54 - $4,115	22%
Blue Cross Blue Shield	$77 - $4,014	32%
Group Hlth Mcr Adv - All Plans	$77 - $1,484	32%
Independent Care Mcr - All Other Plans	$77 - $1,484	32%
Quartz Mcr Adv	$77 - $1,484	32%
Security Hp Mcr Adv	$77 - $1,484	32%
Va Ccn - All Plans	$77 - $1,484	32%
Aetna	$88 - $3,709	36%
Independent Care Mcaid	$141 - $520	58%
Quartz Mcaid	$141 - $520	58%
Security Hp Mcaid	$141 - $520	58%
Managed Hlth Mcaid - All Plans	$157 - $520	64%
The Alliance - All Plans	$392 - $25,963	161%
Security Hp Comm - All Other Plans	$1,356 - $3,709	556%
Quartz Comm - All Other Plans	$1,436 - $3,927	589%
Humana	$1,476 - $4,036	605%
Cigna	$1,548 - $4,233	635%

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 $1,713.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74176.

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 74176.
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.