CMS Price Transparency Data

Culture, blood

Facility: Knoxville Hospital & Clinics

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $69
Cash Discount Price: $72
vs. Medicare Baseline: 6.69x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Knoxville Hospital & Clinics is $69. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 6.69x the Medicare baseline. Located in 1002 South Lincoln Street, Knoxville, IA.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$69

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: $72 (698%)

Insurance Median: $69 (669%)

Cash: $72 (698% of Medicare)

Ins. Median: $69 (669% 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 669% of the Medicare baseline (a markup of 569%). 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
Molina Mcaid/Chip - All Plans	$51	494%
Amerigroup Mcaid	$52	504%
Iowa Total Care Mcaid - All Plans	$52	504%
Aetna	$53	514%
Amerigroup Mcr - All Other Plans	$53	514%
Humana	$53 - $102	514%
UnitedHealthcare	$53 - $111	514%
Wellmark Hmo 7/1/22	$63	610%
Wellmark Ppo 7/1/22-All Other Plans	$69	669%
Oscar-All Plans	$79	766%
Health Partners New Bus	$84	814%
Medical Associates Health Plan-All Other Plans	$90	872%
Cigna	$116	1124%
Health Partners-All Other Plans	$116	1124%
Medica Op And Profee Only-All Plans	$116	1124%
Midlands Choice-All Plans	$116	1124%

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 $72.
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 Knoxville Hospital & Clinics 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.