CMS Price Transparency Data

Culture, blood

Facility: Wabash General Hospital 1

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $155
Cash Discount Price: $207
vs. Medicare Baseline: 15.02x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Wabash General Hospital 1 is $155. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $207. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 15.02x the Medicare baseline. Located in 1418 College Drive, Mount Carmel, IL.

Cash / Self-Pay

$207

Average discount available for prompt cash payment at this facility.

Insurance Median

$155

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: $207 (2006%)

Insurance Median: $155 (1502%)

Cash: $207 (2006% of Medicare)

Ins. Median: $155 (1502% 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 1502% of the Medicare baseline (a markup of 1402%). 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	$21 - $176	203%
Blue Cross Blue Shield	$21 - $180	203%
Meridian Mcaid - All Plans	$21	203%
Molina Mcaid - All Plans	$21	203%
UnitedHealthcare	$47 - $64	455%
Health Alliance Mcr Adv - All Plans	$65	630%
Healthlink Hmo	$145	1405%
Cigna	$155	1502%
Encore Combined Ip/Op Only	$155	1502%
Hope Trust - All Plans	$155	1502%
Healthlink Ppo - All Other Plans	$166	1609%
Phcs - All Plans	$166	1609%
Health Smart - All Plans	$176	1705%
Hfn - All Plans	$176	1705%
Multiplan - All Plans	$176	1705%
Siho Network - All Plans	$176	1705%
Encore Health Network Ip/Op Only - All Other Plans	$186	1802%

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 $207.
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 Wabash General Hospital 1 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.