CMS Price Transparency Data

Trauma team activation

Facility: Tomah Memorial Hospital

Billing Code: G0390 (HCPCS)

No verified fair price for this procedure here

This hospital only published government or network rates for this billing code — not a standard commercial price — so we can’t show a verified fair-price comparison for it. What it charges each insurer is listed below; call the hospital’s billing office to confirm the actual charge.

modeled estimate · not a bill or quote

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$550 - $1,525	40%
Blue Cross Blue Shieldmajor	$550 - $1,488	40%
Aetnamajor	$1,051 - $1,375	77%
Cignamajor	$1,229 - $1,569	90%
Humanamajor	$550 - $1,496	40%
Quartz	$550 - $1,456	40%
+ 5 smaller / regional plans	$550 - $1,504

Government programs also on file: Military & VA.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 930), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the HCPCS code on your bill matches exactly: G0390.

Insurance Before you use insurance

Call your insurance company to confirm Tomah Memorial Hospital is in-network.
Ask your insurer whether prior approval is required for HCPCS code G0390.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Tomah Memorial Hospital

Compare: Trauma team activation at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.