CMS Price Transparency Data

Culture, blood

Facility: Norton-King's Daughters' Health

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $158
Cash Discount Price: $44
vs. Medicare Baseline: 15.31x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Norton-King's Daughters' Health is $158. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $44. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 15.31x the Medicare baseline. Located in 1373 East Sr 62, Madison, IN.

Cash / Self-Pay

$44

Average discount available for prompt cash payment at this facility.

Insurance Median

$158

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: $44 (426%)

Insurance Median: $158 (1531%)

Cash: $44 (426% of Medicare)

Ins. Median: $158 (1531% 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 1531% of the Medicare baseline (a markup of 1431%). 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	$8 - $177	78%
Blue Cross Blue Shield	$10 - $32	97%
Humana	$10	97%
Managed Health Services Of Indiana	$10	97%
Managed Health Services Of Kentucky	$10	97%
Passport By Molina	$10	97%
UnitedHealthcare	$10 - $158	97%
Managed Health Services	$11 - $16	107%
Caresource Of Kentucky	$14	136%
Caresource Of Indiana	$15	145%
Custom Design Benefits	$21 - $100	203%
Cigna	$171	1657%
Encore	$171	1657%
Quality Care Partners	$179	1734%
Bluegrass	$181	1754%
First Health	$181	1754%
Healthlink	$181	1754%
Vha/Tristate	$181	1754%
Multiplan/Phcs	$185	1793%
Indiana Health Network	$191	1851%
Siho	$191	1851%

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 $44.
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 Norton-King's Daughters' Health 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.