CMS Price Transparency Data

Culture, blood

Facility: Cass County Memorial Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $50
Cash Discount Price: $82
vs. Medicare Baseline: 4.84x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Cass County Memorial Hospital is $50. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $82. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 4.84x the Medicare baseline. Located in 1501 East Tenth Street, Atlantic, IA.

Cash / Self-Pay

$82

Average discount available for prompt cash payment at this facility.

Insurance Median

$50

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: $82 (795%)

Insurance Median: $50 (484%)

Cash: $82 (795% of Medicare)

Ins. Median: $50 (484% 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 484% of the Medicare baseline (a markup of 384%). 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
UnitedHealthcare	$10 - $49	97%
Midlands Choice Medica Mcr	$23	223%
Wellmark Hmo	$36	349%
Wellmark Ppo - All Other Plans	$39	378%
Triwest - All Plans	$48	465%
Aetna	$49 - $111	475%
Amerigroup Mcr Adv - All Other Plans	$49	475%
Medica Mcr Adv	$49	475%
Tricare	$49	475%
Va Ccn - All Plans	$49	475%
Iowa Total Care Mcaid	$50	484%
Iowa Total Care Mcr	$50	484%
Molina Mcaid - All Plans	$50	484%
Wellmark Mcr Adv	$50	484%
American Hlth Mcr Adv - All Plans	$51	494%
Medicaid / KanCare	$51	494%
Iowa Total Care Comm - All Other Plans	$54	523%
Midlands Choice New Bus	$76	736%
Medica Comm - All Other Plans	$103	998%
Midlands Choice Pho (Ppo) - All Other Plans	$105	1017%
Multiplan - All Plans	$111	1076%

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 $82.
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 Cass County Memorial Hospital 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.