CMS Price Transparency Data

Culture, blood

Facility: Kossuth Regional Health Center

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $62
Cash Discount Price: $97
vs. Medicare Baseline: 6.01x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Kossuth Regional Health Center is $62. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $97. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 6.01x the Medicare baseline. Located in 1515 South Phillips Street, Algona, IA.

Cash / Self-Pay

$97

Average discount available for prompt cash payment at this facility.

Insurance Median

$62

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: $97 (940%)

Insurance Median: $62 (601%)

Cash: $97 (940% of Medicare)

Ins. Median: $62 (601% 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 601% of the Medicare baseline (a markup of 501%). 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
Blue Cross Blue Shield	$9 - $10	87%
Amerigroup Mcr Adv - All Other Plans	$23 - $71	223%
Humana	$23 - $70	223%
Mercy One - All Plans	$23 - $70	223%
UnitedHealthcare	$23 - $139	223%
Va Ccn - All Plans	$23 - $70	223%
Health Partners New Bus - All Other Plans	$42 - $128	407%
Midlands Choice - All Plans	$42 - $128	407%
Medical Associates - All Plans	$51 - $156	494%
Preferred Health - All Plans	$51 - $156	494%
Aetna	$56 - $178	543%
Multiplan - All Plans	$57 - $174	552%
Health Partners Exisiting Bus	$58 - $178	562%
Amerigroup Mcaid	$62 - $190	601%
Molina Mcaid/Chip - All Plans	$62 - $188	601%

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 $97.
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 Kossuth Regional Health 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.