CMS Price Transparency Data

Blood test, sodium

Facility: Stoughton Hospital

Billing Code: 84295 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84295
Insurance Median: $27
Cash Discount Price: $48
vs. Medicare Baseline: 5.61x Medicare

The contracted insurance negotiated median rate for a Blood test, sodium at Stoughton Hospital is $27. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $48. Compared to the federal Medicare reimbursement reference rate of $4.81, this hospital’s rate is 5.61x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$48

Average discount available for prompt cash payment at this facility.

Insurance Median

$27

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$4.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $4.81 (100%)

Cash / Self-Pay: $48 (998%)

Insurance Median: $27 (561%)

Cash: $48 (998% of Medicare)

Ins. Median: $27 (561% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $4.81 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 561% of the Medicare baseline (a markup of 461%). 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	$4	83%
Medicaid / KanCare	$5	104%
Tricare	$21	437%
Healthnet Mcr Adv - All Plans	$23	478%
Dean Health Insurance Med Adv	$25	520%
Humana	$25 - $79	520%
Quartz Mcr Adv	$25	520%
Security Health/First Health - All Plans	$25	520%
Aetna	$26 - $75	541%
Dean Health Insurance Comm - All Other Plans	$27	561%
Dean Health Insurance Epo	$27	561%
UnitedHealthcare	$39 - $70	811%
Geha - All Plans	$66	1372%
Quartz Health Solutions - All Other Lans	$69	1435%
Cigna	$70	1455%
Wisconsin Ppo Ppa Direct - All Plans	$70	1455%
Blue Cross Blue Shield	$77	1601%
Wps - All Plans	$79	1642%

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 $48.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 84295.

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 84295.
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.