CMS Price Transparency Data

Culture, blood

Facility: Memorial Hospital and Manor

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $164
Cash Discount Price: $149
vs. Medicare Baseline: 15.89x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Memorial Hospital and Manor is $164. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $149. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 15.89x the Medicare baseline. Located in 1500 E Shotwell Street, Bainbridge, GA.

Cash / Self-Pay

$149

Average discount available for prompt cash payment at this facility.

Insurance Median

$164

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: $149 (1444%)

Insurance Median: $164 (1589%)

Cash: $149 (1444% of Medicare)

Ins. Median: $164 (1589% 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 1589% of the Medicare baseline (a markup of 1489%). 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
Aetna	$10 - $192	97%
Humana	$10 - $170	97%
Medicare (plans)	$10	97%
Tricare	$10	97%
Wellcare_Plan	$10	97%
Ambetter / Centene	$13	126%
Amerigroup_Plan	$13	126%
Medicaid / KanCare	$13	126%
Peach_State_Health_Plan_Plan	$13	126%
Caresource_Plan	$14	136%
Alliant_Plan	$17	165%
Blue Cross Blue Shield	$164	1589%
Uhc_Plan	$168	1628%
Novanet_Plan	$170	1647%
Cigna	$177	1715%
Private_Healthcare_Systems_Plan	$181	1754%
Multiplan_Plan	$192	1860%
Corvel_Plan	$202	1957%
Tnga_Plan	$450	4360%

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 $149.
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 Memorial Hospital and Manor 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.