CMS Price Transparency Data

X-ray, lower back

Facility: Stoughton Hospital

Billing Code: 72110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72110
Insurance Median: $385
Cash Discount Price: $503
vs. Medicare Baseline: 3.60x Medicare

The contracted insurance negotiated median rate for a X-ray, lower back at Stoughton Hospital is $385. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $503. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.60x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$503

Average discount available for prompt cash payment at this facility.

Insurance Median

$385

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $503 (471%)

Insurance Median: $385 (360%)

Cash: $503 (471% of Medicare)

Ins. Median: $385 (360% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 360% of the Medicare baseline (a markup of 260%). 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	$67	63%
Tricare	$218	204%
Healthnet Mcr Adv - All Plans	$243	228%
Dean Health Insurance Med Adv	$256	240%
Humana	$256 - $824	240%
Quartz Mcr Adv	$256	240%
Security Health/First Health - All Plans	$256	240%
Aetna	$274 - $778	257%
Quartz Health Solutions - All Other Lans	$381	357%
Dean Health Insurance Comm - All Other Plans	$385	360%
Dean Health Insurance Epo	$385	360%
UnitedHealthcare	$403 - $732	377%
Geha - All Plans	$686	642%
Cigna	$732	685%
Wisconsin Ppo Ppa Direct - All Plans	$732	685%
Blue Cross Blue Shield	$796	745%
Wps - All Plans	$824	771%
Alliance - All Plans	$3,660	3427%

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 $503.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72110.

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 72110.
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.