CMS Price Transparency Data

Culture, blood

Facility: University of Iowa Health Care Medical Center Down

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $143
Cash Discount Price: $167
vs. Medicare Baseline: 13.86x Medicare

The contracted insurance negotiated median rate for a Culture, blood at University of Iowa Health Care Medical Center Down is $143. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $167. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 13.86x the Medicare baseline. Located in 500 E Market Street, Iowa City, IA.

Cash / Self-Pay

$167

Average discount available for prompt cash payment at this facility.

Insurance Median

$143

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: $167 (1618%)

Insurance Median: $143 (1386%)

Cash: $167 (1618% of Medicare)

Ins. Median: $143 (1386% 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 1386% of the Medicare baseline (a markup of 1286%). 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 - $143	97%
Blue Cross Blue Shield	$10 - $115	97%
Iowa Total Care	$10 - $11	97%
Molina Healthcare	$10	97%
UnitedHealthcare	$10 - $101	97%
Wellpoint (Amerigroup)	$10 - $11	97%
Healthpartners	$11 - $203	107%
Immergrun	$60	581%
Medical Associates	$92 - $120	891%
Quad City Community Healthcare	$120 - $179	1163%
Midlands Choice	$125 - $155	1211%
Oscar Health	$151	1463%
Great River Health Systems	$155 - $167	1502%
Aplos Health Plan	$191	1851%
Sedgwick	$191	1851%
Global Excel	$203	1967%
Sanford Health Plan	$203	1967%
Sisco	$210	2035%
Employee Benefit Systems	$215	2083%
Healthsmart	$215	2083%
Hfn	$220	2132%
Multiplan	$220	2132%

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 $167.
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 University of Iowa Health Care Medical Center Down 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.