CMS Price Transparency Data

Family therapy session

Facility: Stoughton Hospital

Billing Code: 90847 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90847
Insurance Median: $518
Cash Discount Price: $479
vs. Medicare Baseline: 2.86x Medicare

The contracted insurance negotiated median rate for a Family therapy session at Stoughton Hospital is $518. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $479. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 2.86x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$479

Average discount available for prompt cash payment at this facility.

Insurance Median

$518

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$181.34

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $181.34 (100%)

Cash / Self-Pay: $479 (264%)

Insurance Median: $518 (286%)

Cash: $479 (264% of Medicare)

Ins. Median: $518 (286% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $181.34 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 286% of the Medicare baseline (a markup of 186%). 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	$195	108%
Tricare	$207	114%
Healthnet Mcr Adv - All Plans	$231	127%
Dean Health Insurance Med Adv	$244	135%
Humana	$244 - $783	135%
Quartz Mcr Adv	$244	135%
Security Health/First Health - All Plans	$244	135%
Aetna	$261 - $740	144%
UnitedHealthcare	$383	211%
Alliance - All Plans	$505	278%
Quartz Health Solutions - All Other Lans	$531	293%
Dean Health Insurance Epo	$537	296%
Dean Health Insurance Comm - All Other Plans	$652	360%
Geha - All Plans	$652	360%
Cigna	$696	384%
Wisconsin Ppo Ppa Direct - All Plans	$696	384%
Blue Cross Blue Shield	$757	417%
Wps - All Plans	$783	432%

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 $479.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90847.

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 90847.
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.