CMS Price Transparency Data

Ultrasound, abdomen (limited)

Facility: Tomah Memorial Hospital

Billing Code: 76705 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76705
Insurance Median: $109
Cash Discount Price: $155
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Ultrasound, abdomen (limited) at Tomah Memorial Hospital is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $155. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.02x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$155

Average discount available for prompt cash payment at this facility.

Insurance Median

$109

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $155 (145%)

Insurance Median: $109 (102%)

Cash: $155 (145% of Medicare)

Ins. Median: $109 (102% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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.

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	$18 - $303	17%
Blue Cross Blue Shield	$26 - $296	24%
Group Hlth Mcr Adv - All Plans	$26 - $109	24%
Independent Care Mcr - All Other Plans	$26 - $109	24%
Quartz Mcr Adv	$26 - $109	24%
Security Hp Mcr Adv	$26 - $109	24%
Va Ccn - All Plans	$26 - $109	24%
Aetna	$30 - $273	28%
Independent Care Mcaid	$87 - $175	81%
Managed Hlth Mcaid - All Plans	$87 - $175	81%
Quartz Mcaid	$87 - $175	81%
Security Hp Mcaid	$87 - $175	81%
Humana	$109 - $298	102%
The Alliance - All Plans	$135 - $483	126%
Security Hp Comm - All Other Plans	$184 - $273	172%
Quartz Comm - All Other Plans	$195 - $290	183%
Cigna	$210 - $312	197%

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 $155.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 76705.

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 76705.
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.