CMS Price Transparency Data

Urinalysis (automated, with microscopy)

Facility: Stoughton Hospital

Billing Code: 81001 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 81001
Insurance Median: $33
Cash Discount Price: $61
vs. Medicare Baseline: 10.41x Medicare

The contracted insurance negotiated median rate for a Urinalysis (automated, with microscopy) at Stoughton Hospital is $33. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $61. Compared to the federal Medicare reimbursement reference rate of $3.17, this hospital’s rate is 10.41x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$61

Average discount available for prompt cash payment at this facility.

Insurance Median

$33

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$3.17

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $3.17 (100%)

Cash / Self-Pay: $61 (1924%)

Insurance Median: $33 (1041%)

Cash: $61 (1924% of Medicare)

Ins. Median: $33 (1041% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $3.17 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 1041% of the Medicare baseline (a markup of 941%). 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	$3	95%
Alliance - All Plans	$4	126%
Dean Health Insurance Comm - All Other Plans	$18	568%
Dean Health Insurance Epo	$18	568%
Tricare	$26	820%
Healthnet Mcr Adv - All Plans	$30	946%
Dean Health Insurance Med Adv	$31	978%
Humana	$31 - $100	978%
Quartz Mcr Adv	$31	978%
Security Health/First Health - All Plans	$31	978%
Aetna	$33 - $94	1041%
Quartz Health Solutions - All Other Lans	$33	1041%
UnitedHealthcare	$49 - $89	1546%
Geha - All Plans	$83	2618%
Cigna	$89	2808%
Wisconsin Ppo Ppa Direct - All Plans	$89	2808%
Blue Cross Blue Shield	$97	3060%
Wps - All Plans	$100	3155%

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 $61.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 81001.

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 81001.
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.