CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: Stoughton Hospital

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $102
Cash Discount Price: $151
vs. Medicare Baseline: 5.55x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at Stoughton Hospital is $102. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $151. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 5.55x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$151

Average discount available for prompt cash payment at this facility.

Insurance Median

$102

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$18.39

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $18.39 (100%)

Cash / Self-Pay: $151 (821%)

Insurance Median: $102 (555%)

Cash: $151 (821% of Medicare)

Ins. Median: $102 (555% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $18.39 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 555% of the Medicare baseline (a markup of 455%). 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
Medicaid / KanCare	$12	65%
Alliance - All Plans	$51	277%
Tricare	$65	353%
Healthnet Mcr Adv - All Plans	$73	397%
Dean Health Insurance Med Adv	$77	419%
Humana	$77 - $248	419%
Quartz Mcr Adv	$77	419%
Security Health/First Health - All Plans	$77	419%
Aetna	$82 - $234	446%
Dean Health Insurance Comm - All Other Plans	$102	555%
Dean Health Insurance Epo	$102	555%
UnitedHealthcare	$121 - $220	658%
Geha - All Plans	$206	1120%
Cigna	$220	1196%
Wisconsin Ppo Ppa Direct - All Plans	$220	1196%
Quartz Health Solutions - All Other Lans	$231	1256%
Blue Cross Blue Shield	$239	1300%
Wps - All Plans	$248	1349%

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 $151.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 84153.

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 84153.
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.