CMS Price Transparency Data

Culture, blood

Facility: Stoughton Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $78
Cash Discount Price: $143
vs. Medicare Baseline: 7.56x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Stoughton Hospital is $78. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $143. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 7.56x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$143

Average discount available for prompt cash payment at this facility.

Insurance Median

$78

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.32

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.32 (100%)

Cash / Self-Pay: $143 (1386%)

Insurance Median: $78 (756%)

Cash: $143 (1386% of Medicare)

Ins. Median: $78 (756% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.32 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 756% of the Medicare baseline (a markup of 656%). 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	$8	78%
Alliance - All Plans	$27	262%
Dean Health Insurance Comm - All Other Plans	$58	562%
Dean Health Insurance Epo	$58	562%
Tricare	$62	601%
Healthnet Mcr Adv - All Plans	$69	669%
Dean Health Insurance Med Adv	$73	707%
Humana	$73 - $234	707%
Quartz Mcr Adv	$73	707%
Security Health/First Health - All Plans	$73	707%
Aetna	$78 - $221	756%
UnitedHealthcare	$114 - $208	1105%
Quartz Health Solutions - All Other Lans	$134	1298%
Geha - All Plans	$195	1890%
Cigna	$208	2016%
Wisconsin Ppo Ppa Direct - All Plans	$208	2016%
Blue Cross Blue Shield	$226	2190%
Wps - All Plans	$234	2267%

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 $143.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 87040.

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 87040.
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.