CMS Price Transparency Data

Culture, blood

Facility: Modoc Medical Center

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $161
Cash Discount Price: $185
vs. Medicare Baseline: 15.60x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Modoc Medical Center is $161. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $185. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 15.60x the Medicare baseline. Located in 1111 N Nagle Street, Alturas, CA.

Cash / Self-Pay

$185

Average discount available for prompt cash payment at this facility.

Insurance Median

$161

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: $185 (1793%)

Insurance Median: $161 (1560%)

Cash: $185 (1793% of Medicare)

Ins. Median: $161 (1560% 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 1560% of the Medicare baseline (a markup of 1460%). 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
Integrated Hp Wc	$10	97%
Multiplan Wc	$10	97%
Ntwrks By Design Wc - All Plans	$10	97%
Adv Med Mgmt - All Plans	$12	116%
Medi-Cal	$12	116%
Medi-Cal 7/1/24	$12	116%
Partnership Hp - All Plans	$12	116%
Blue Shield Mcr Adv	$100	969%
Blue Shield Va	$100	969%
UnitedHealthcare	$100 - $176	969%
Tricare	$106	1027%
Healthnet Mcr Adv	$107	1037%
Blue Cross Blue Shield	$152 - $169	1473%
Blue Shield Exch	$152	1473%
Blue Shield Comm - All Other Plans	$169	1638%
Carelon - All Plans	$169	1638%
Corvel - All Plans	$174	1686%
Aetna	$176	1705%
Coventry/First Health - All Plans	$176	1705%
Galaxy Health - All Plans	$176	1705%
Healthnet Comm - All Other Plans	$176	1705%
Hmn - All Plans	$176	1705%
Integrated Hp - All Other Plans	$176	1705%
Interplan - All Plans	$176	1705%
Multiplan - All Other Plans	$176	1705%
Superior Ca Ppo - All Plans	$176	1705%

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 $185.
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 Modoc Medical Center 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.