CMS Price Transparency Data

Psychotherapy session (45 minutes)

Facility: Stoughton Hospital

Billing Code: 90834 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90834
Insurance Median: $463
Cash Discount Price: $428
vs. Medicare Baseline: 2.55x Medicare

The contracted insurance negotiated median rate for a Psychotherapy session (45 minutes) at Stoughton Hospital is $463. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $428. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 2.55x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$428

Average discount available for prompt cash payment at this facility.

Insurance Median

$463

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: $428 (236%)

Insurance Median: $463 (255%)

Cash: $428 (236% of Medicare)

Ins. Median: $463 (255% 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 255% of the Medicare baseline (a markup of 155%). 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	$164	90%
Tricare	$185	102%
Healthnet Mcr Adv - All Plans	$207	114%
Dean Health Insurance Med Adv	$218	120%
Humana	$218 - $700	120%
Quartz Mcr Adv	$218	120%
Security Health/First Health - All Plans	$218	120%
Aetna	$233 - $661	128%
UnitedHealthcare	$342	189%
Alliance - All Plans	$451	249%
Quartz Health Solutions - All Other Lans	$475	262%
Dean Health Insurance Epo	$480	265%
Dean Health Insurance Comm - All Other Plans	$583	321%
Geha - All Plans	$584	322%
Cigna	$622	343%
Wisconsin Ppo Ppa Direct - All Plans	$622	343%
Blue Cross Blue Shield	$677	373%
Wps - All Plans	$700	386%

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 $428.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90834.

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 90834.
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.