CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Tomah Memorial Hospital

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $12,240
Cash Discount Price: $7,816
vs. Medicare Baseline: 2.16x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Tomah Memorial Hospital is $12,240. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,816. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 2.16x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$7,816

Average discount available for prompt cash payment at this facility.

Insurance Median

$12,240

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$5,675.87

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $5,675.87 (100%)

Cash / Self-Pay: $7,816 (138%)

Insurance Median: $12,240 (216%)

Cash: $7,816 (138% of Medicare)

Ins. Median: $12,240 (216% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $5,675.87 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 216% of the Medicare baseline (a markup of 116%). 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
Cigna	$10,330 - $13,185	182%
Blue Cross Blue Shield	$11,430 - $12,505	201%
Independent Care Mcaid	$11,430	201%
Managed Hlth Mcaid - All Plans	$11,430	201%
Quartz Mcaid	$11,430	201%
Security Hp Mcaid	$11,430	201%
Aetna	$11,554 - $12,101	204%
Security Hp Comm - All Other Plans	$11,554	204%
Quartz Comm - All Other Plans	$12,233	216%
Group Hlth Mcr Adv - All Plans	$12,240	216%
Humana	$12,240 - $12,573	216%
Independent Care Mcr - All Other Plans	$12,240	216%
Quartz Mcr Adv	$12,240	216%
Security Hp Mcr Adv	$12,240	216%
UnitedHealthcare	$12,240 - $12,818	216%
Va Ccn - All Plans	$12,240	216%
The Alliance - All Plans	$12,777	225%

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 $7,816.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 392.

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 MS-DRG code 392.
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.