CMS Price Transparency Data

Culture, blood

Facility: Methodist Hospitals Inc

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $185
Cash Discount Price: $354
vs. Medicare Baseline: 17.93x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Methodist Hospitals Inc is $185. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $354. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 17.93x the Medicare baseline. Located in 600 Grant St, Gary, IN.

Cash / Self-Pay

$354

Average discount available for prompt cash payment at this facility.

Insurance Median

$185

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: $354 (3430%)

Insurance Median: $185 (1793%)

Cash: $354 (3430% of Medicare)

Ins. Median: $185 (1793% 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 1793% of the Medicare baseline (a markup of 1693%). 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	$2 - $562	19%
Magnacare	$5 - $27	48%
Blue Cross Blue Shield	$10 - $666	97%
Caresource	$10	97%
Humana	$10	97%
Managed Health Services	$10	97%
Medicaid / KanCare	$10	97%
Medicare (plans)	$10	97%
United Heathcare	$10	97%
UnitedHealthcare	$10 - $15	97%
Zing	$11	107%
Caresource Maketplace	$17	165%
Ambetter / Centene	$21	203%
Physicians Health Plan Of Northern Indiana	$31	300%
Cigna	$97 - $316	940%
Encore	$152 - $676	1473%
Phcs	$172 - $516	1667%
Siho	$177 - $531	1715%
Sagamore	$182 - $546	1764%
Multiplan	$185 - $554	1793%
Hfn	$197 - $645	1909%

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 $354.
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 Methodist Hospitals Inc 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.