CMS Price Transparency Data

Blood transfusion

Facility: Stoughton Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $351
Cash Discount Price: $631
vs. Medicare Baseline: 0.78x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Stoughton Hospital is $351. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $631. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 0.78x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$631

Average discount available for prompt cash payment at this facility.

Insurance Median

$351

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$450.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $450.73 (100%)

Cash / Self-Pay: $631 (140%)

Insurance Median: $351 (78%)

Cash: $631 (140% of Medicare)

Ins. Median: $351 (78% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $450.73 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
Medicaid / KanCare	$19 - $549	4%
Healthnet Mcr Adv - All Plans	$38 - $318	8%
Humana	$38 - $1,075	8%
Tricare	$38 - $284	8%
Aetna	$45 - $1,016	10%
Dean Health Insurance Med Adv	$45 - $335	10%
Quartz Mcr Adv	$45 - $335	10%
Security Health/First Health - All Plans	$45 - $335	10%
UnitedHealthcare	$45 - $956	10%
Blue Cross Blue Shield	$56 - $1,039	12%
Quartz Health Solutions - All Other Lans	$69 - $729	15%
Geha - All Plans	$154 - $896	34%
Cigna	$164 - $956	36%
Wisconsin Ppo Ppa Direct - All Plans	$164 - $956	36%
Alliance - All Plans	$166 - $693	37%
Dean Health Insurance Comm - All Other Plans	$451 - $895	100%
Dean Health Insurance Epo	$451 - $738	100%
Wps - All Plans	$1,032 - $1,314	229%

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 $631.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 36430.

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 36430.
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.