CMS Price Transparency Data

X-ray, chest (single view)

Facility: Tomah Memorial Hospital

Billing Code: 71045 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 71045
Insurance Median: $71
Cash Discount Price: $93
vs. Medicare Baseline: 0.80x Medicare

The contracted insurance negotiated median rate for a X-ray, chest (single view) at Tomah Memorial Hospital is $71. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $93. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 0.80x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$93

Average discount available for prompt cash payment at this facility.

Insurance Median

$71

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: $93 (105%)

Insurance Median: $71 (80%)

Cash: $93 (105% of Medicare)

Ins. Median: $71 (80% 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 - $198	7%
Blue Cross Blue Shield	$8 - $193	9%
Group Hlth Mcr Adv - All Plans	$8 - $71	9%
Independent Care Mcr - All Other Plans	$8 - $71	9%
Quartz Mcr Adv	$8 - $71	9%
Security Hp Mcr Adv	$8 - $71	9%
Va Ccn - All Plans	$8 - $71	9%
Aetna	$9 - $178	10%
Independent Care Mcaid	$14 - $89	16%
Managed Hlth Mcaid - All Plans	$14 - $89	16%
Quartz Mcaid	$14 - $89	16%
Security Hp Mcaid	$14 - $89	16%
The Alliance - All Plans	$41 - $315	46%
Humana	$71 - $194	80%
Security Hp Comm - All Other Plans	$97 - $178	109%
Quartz Comm - All Other Plans	$102 - $189	115%
Cigna	$110 - $203	124%

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 $93.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 71045.

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 71045.
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.