CMS Price Transparency Data

Blood test, hemoglobin

Facility: Stoughton Hospital

Billing Code: 85018 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85018
Insurance Median: $20
Cash Discount Price: $37
vs. Medicare Baseline: 8.44x Medicare

The contracted insurance negotiated median rate for a Blood test, hemoglobin at Stoughton Hospital is $20. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $37. Compared to the federal Medicare reimbursement reference rate of $2.37, this hospital’s rate is 8.44x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$37

Average discount available for prompt cash payment at this facility.

Insurance Median

$20

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$2.37

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $2.37 (100%)

Cash / Self-Pay: $37 (1561%)

Insurance Median: $20 (844%)

Cash: $37 (1561% of Medicare)

Ins. Median: $20 (844% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $2.37 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 844% of the Medicare baseline (a markup of 744%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Alliance - All Plans	$2	84%
Medicaid / KanCare	$6	253%
Dean Health Insurance Comm - All Other Plans	$13	549%
Dean Health Insurance Epo	$13	549%
Tricare	$16	675%
Healthnet Mcr Adv - All Plans	$18	759%
Dean Health Insurance Med Adv	$19	802%
Humana	$19 - $60	802%
Quartz Mcr Adv	$19	802%
Security Health/First Health - All Plans	$19	802%
Aetna	$20 - $57	844%
UnitedHealthcare	$29 - $54	1224%
Geha - All Plans	$50	2110%
Cigna	$54	2278%
Wisconsin Ppo Ppa Direct - All Plans	$54	2278%
Blue Cross Blue Shield	$58	2447%
Quartz Health Solutions - All Other Lans	$58	2447%
Wps - All Plans	$60	2532%

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 $37.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 85018.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Stoughton Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 85018.
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.