CMS Price Transparency Data

Culture, blood

Facility: Hamilton Memorial Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $129
Cash Discount Price: $137
vs. Medicare Baseline: 12.50x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Hamilton Memorial Hospital is $129. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $137. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 12.50x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$137

Average discount available for prompt cash payment at this facility.

Insurance Median

$129

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: $137 (1328%)

Insurance Median: $129 (1250%)

Cash: $137 (1328% of Medicare)

Ins. Median: $129 (1250% 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 1250% of the Medicare baseline (a markup of 1150%). 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
Medicaid / KanCare	$60 - $64	581%
Blue Cross Blue Shield	$61 - $146	591%
Aetna	$64 - $145	620%
Health Alliance	$64 - $129	620%
Humana	$64	620%
Medicare (plans)	$64	620%
UnitedHealthcare	$64 - $115	620%
Wellcare	$64	620%
Alliance Coal	$112	1085%
Healthscope	$112	1085%
Wellfirst (Ssmhic)	$112	1085%
Hope Trust	$120	1163%
Cigna	$126	1221%
Hfn, Inc	$129 - $145	1250%
Healthlink	$137 - $145	1328%
Multiplan	$137	1328%
Siho	$145	1405%
Three Rivers Provider	$145	1405%
Healthsmart	$153	1483%
Stratose	$153	1483%

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 $137.
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 Hamilton 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.