CMS Price Transparency Data

Culture, blood

Facility: Memorial Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $178
Cash Discount Price: $194
vs. Medicare Baseline: 17.25x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Memorial Hospital is $178. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $194. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 17.25x the Medicare baseline. Located in 4500 Memorial Drive, Belleville, IL.

Cash / Self-Pay

$194

Average discount available for prompt cash payment at this facility.

Insurance Median

$178

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: $194 (1880%)

Insurance Median: $178 (1725%)

Cash: $194 (1880% of Medicare)

Ins. Median: $178 (1725% 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 1725% of the Medicare baseline (a markup of 1625%). 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 - $242	97%
Humana	$10 - $29	97%
Blue Cross Blue Shield	$11 - $281	107%
Cox Health [757]	$11	107%
Devoted Health Plan [847]	$11	107%
Essence Healthcare [221]	$11	107%
Medica [662]	$11	107%
UnitedHealthcare	$11 - $240	107%
Healthscope Benefits [258]	$12	116%
Cigna	$14 - $22	136%
Allied Benefits [498]	$18 - $240	174%
Consociate [478]	$18	174%
Coresource [497]	$18	174%
Fmh Benefit Service Inc [222]	$18	174%
Mail Handlers [495]	$18	174%
Sarah Bush Lincoln [636]	$18	174%
Apwu Health Plan [216]	$22	213%
Nalc Health Benefit Plan [242]	$22	213%
Priority Health [648]	$22	213%
Healthlink [225]	$157 - $244	1521%
Cox Health Systems Insurance Company [220]	$178 - $210	1725%
Health Alliance [224]	$178	1725%
Hope Trust [806]	$187	1812%
Med-Pay [480]	$210 - $242	2035%
Unicare [568]	$210 - $244	2035%
First Health Commercial [734]	$240	2326%
Beechstreet [551]	$242	2345%
Detego Health [868]	$242	2345%
Health Systems Inc [620]	$242	2345%
Healthcare Sol Mercy [609]	$242	2345%
Multiplan Commercial [737]	$242	2345%
Multiplan [240]	$242	2345%
Phcs [244]	$242 - $258	2345%
Preferred Health Professionals [561]	$244	2364%
Hfn [563]	$258	2500%
Medica [661]	$258	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 $194.
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 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.