CMS Price Transparency Data

Culture, blood

Facility: Craig Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $1,201
Cash Discount Price: $665
vs. Medicare Baseline: 116.38x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Craig Hospital is $1,201. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $665. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 116.38x the Medicare baseline. Located in 3425 S Clarkson St, Englewood, CO.

Cash / Self-Pay

$665

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,201

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: $665 (6444%)

Insurance Median: $1,201 (11638%)

Cash: $665 (6444% of Medicare)

Ins. Median: $1,201 (11638% 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 11638% of the Medicare baseline (a markup of 11538%). 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
Veterans Administration	$9	87%
Cms	$10	97%
UnitedHealthcare	$10 - $870	97%
Cigna	$882	8547%
Kaiser	$908	8798%
Blue Cross Blue Shield	$926	8973%
Carisk Outcomes	$961	9312%
Zenith	$1,041	10087%
Aetna	$1,089	10552%
Corvel Worker'S Comp	$1,121	10862%
Liberty Mutual Worker'S Comp	$1,121	10862%
Paradigm	$1,121 - $1,185	10862%
Rocky Mountain Health Plan	$1,169 - $1,249	11328%
Midwest Employers Casualty	$1,185	11483%
Coventry/First Health	$1,201	11638%
Fcci Worker'S Comp	$1,201	11638%
Geha/Ppo Usa	$1,201	11638%
Great-West Healthcare	$1,201	11638%
Multiplan/Phcs	$1,201 - $1,265	11638%
Prime Health Services	$1,217	11793%
First Choice Health	$1,249	12103%
Focus Worker'S Comp	$1,281	12413%
General Reinsurance	$1,281 - $1,361	12413%
Provider Network Of America	$1,281	12413%
Three Rivers Provider Network	$1,281 - $1,313	12413%
Wyoming Worker'S Comp	$1,281	12413%
Allstate	$1,361	13188%
Tricare	$1,361	13188%
National Provider Network	$1,441	13963%
Up & Up	$1,441	13963%

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 $665.
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 Craig Hospital 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.