CMS Price Transparency Data

X-ray, ankle

Facility: Tomah Memorial Hospital

Billing Code: 73610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73610
Insurance Median: $99
Cash Discount Price: $133
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a X-ray, ankle at Tomah Memorial Hospital is $99. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $133. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 1.11x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$133

Average discount available for prompt cash payment at this facility.

Insurance Median

$99

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$88.91

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $88.91 (100%)

Cash / Self-Pay: $133 (150%)

Insurance Median: $99 (111%)

Cash: $133 (150% of Medicare)

Ins. Median: $99 (111% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $88.91 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	$6 - $275	7%
Blue Cross Blue Shield	$8 - $268	9%
Group Hlth Mcr Adv - All Plans	$8 - $99	9%
Independent Care Mcr - All Other Plans	$8 - $99	9%
Quartz Mcr Adv	$8 - $99	9%
Security Hp Mcr Adv	$8 - $99	9%
Va Ccn - All Plans	$8 - $99	9%
Aetna	$9 - $248	10%
Independent Care Mcaid	$27 - $89	30%
Managed Hlth Mcaid - All Plans	$27 - $89	30%
Quartz Mcaid	$27 - $89	30%
Security Hp Mcaid	$27 - $89	30%
The Alliance - All Plans	$41 - $437	46%
Humana	$99 - $270	111%
Security Hp Comm - All Other Plans	$145 - $248	163%
Quartz Comm - All Other Plans	$154 - $262	173%
Cigna	$166 - $283	187%

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 $133.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 73610.

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 73610.
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.