CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Tomah Memorial Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99203
  • Insurance Median: $178
  • Cash Discount Price: $135
  • vs. Medicare Baseline: 1.51x Medicare
The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Tomah Memorial Hospital is $178. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $135. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.51x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.
Cash / Self-Pay
$135

Average discount available for prompt cash payment at this facility.

Insurance Median
$178

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)
Cash / Self-Pay: $135 (115%)
Insurance Median: $178 (151%)
Cash: $135 (115% of Medicare)
Ins. Median: $178 (151% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $117.57 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.

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
UnitedHealthcare $57 - $848 48%
Blue Cross Blue Shield $74 - $828 63%
Independent Care Mcaid $74 63%
Managed Hlth Mcaid - All Plans $74 63%
Quartz Mcaid $74 63%
Security Hp Mcaid $74 63%
Group Hlth Mcr Adv - All Plans $80 - $306 68%
Humana $80 - $832 68%
Independent Care Mcr - All Other Plans $80 - $306 68%
Quartz Mcr Adv $80 - $306 68%
Security Hp Mcr Adv $80 - $306 68%
Va Ccn - All Plans $80 - $306 68%
The Alliance - All Plans $114 - $837 97%
Aetna $121 - $765 103%
Security Hp Comm - All Other Plans $121 - $765 103%
Quartz Comm - All Other Plans $128 - $810 109%
Cigna $138 - $873 117%

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