CMS Price Transparency Data

Culture, blood

Facility: Clay County Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $198
Cash Discount Price: $319
vs. Medicare Baseline: 19.19x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Clay County Hospital is $198. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $319. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 19.19x the Medicare baseline. Located in 911 Stacy Burk Dr, Flora, IL.

Cash / Self-Pay

$319

Average discount available for prompt cash payment at this facility.

Insurance Median

$198

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: $319 (3091%)

Insurance Median: $198 (1919%)

Cash: $319 (3091% of Medicare)

Ins. Median: $198 (1919% 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 1919% of the Medicare baseline (a markup of 1819%). 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	$4 - $234	39%
UnitedHealthcare	$10 - $255	97%
Aetna	$86 - $252	833%
Ambetter / Centene	$86	833%
Medica(Wellfirst)	$86 - $198	833%
Meridian	$86	833%
Wellcare	$86	833%
Healthlink	$207 - $255	2006%
Cigna	$255	2471%
Usa Mco	$303	2936%

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 $319.
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 Clay County 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.