CMS Price Transparency Data

Culture, blood

Facility: Palos Community Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $258
Cash Discount Price: $202
vs. Medicare Baseline: 25.00x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Palos Community Hospital is $258. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $202. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 25.00x the Medicare baseline. Located in 12251 South 80Th Avenue, Palos Heights, IL.

Cash / Self-Pay

$202

Average discount available for prompt cash payment at this facility.

Insurance Median

$258

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: $202 (1957%)

Insurance Median: $258 (2500%)

Cash: $202 (1957% of Medicare)

Ins. Median: $258 (2500% 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 2500% of the Medicare baseline (a markup of 2400%). 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	$41 - $1,057	397%
Aetna	$55 - $1,057	533%
Carelon Behavioral Health [159]	$129 - $528	1250%
Healthlink [125]	$129 - $1,057	1250%
Magellan Behavioral Hlth [136]	$155 - $634	1502%
Multiplan/Phcs [142]	$181 - $1,057	1754%
Compsych [112]	$194 - $793	1880%
First Health Plan [6034]	$194 - $793	1880%
Beechstreet [176]	$206 - $846	1996%
Cigna	$206 - $1,057	1996%
Health'S Finest Network [126]	$219 - $898	2122%
Galaxy Health Network [220]	$258 - $1,057	2500%
Global Excel [1712]	$258 - $1,057	2500%
Health Alliance [181]	$258 - $1,057	2500%
UnitedHealthcare	$258 - $1,057	2500%

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 $202.
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 Palos Community 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.