CMS Price Transparency Data

Culture, blood

Facility: North Hawaii Community Hospital, Inc

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $10
Cash Discount Price: $229
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a Culture, blood at North Hawaii Community Hospital, Inc is $10. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $229. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 0.97x the Medicare baseline. Located in 67 1125 Mamalahoa Highway, Kamuela, HI.

Cash / Self-Pay

$229

Average discount available for prompt cash payment at this facility.

Insurance Median

$10

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: $229 (2219%)

Insurance Median: $10 (97%)

Cash: $229 (2219% of Medicare)

Ins. Median: $10 (97% 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.

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
Alohacare	$10	97%
Hmsa	$10 - $27	97%
Kaiser	$10 - $29	97%
Mdx Hawaii	$10	97%
Ohana Care	$10	97%
United Behavioral Health	$10	97%
UnitedHealthcare	$10	97%
Hawaii Community Health Alliance	$11	107%
Hawaii Mainland Administrators	$11	107%
University Health Alliance	$19	184%
Hawaii Laborers	$23	223%

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 $229.
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 North Hawaii Community Hospital, Inc 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.