CMS Price Transparency Data

Culture, blood

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $13
Cash Discount Price: $104
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a Culture, blood at UMass Memorial Healthalliance Hospitals is $13. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $104. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 1.26x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$104

Average discount available for prompt cash payment at this facility.

Insurance Median

$13

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: $104 (1008%)

Insurance Median: $13 (126%)

Cash: $104 (1008% of Medicare)

Ins. Median: $13 (126% 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.

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
Institution [10406]	$9 - $55	87%
Masshealth [20302]	$9	87%
Medicaid / KanCare	$9 - $11	87%
Cigna	$10 - $40	97%
Medicare (plans)	$10	97%
Tufts Dual [10111]	$10	97%
Tufts Us Family [11203]	$10	97%
Aetna	$11 - $68	107%
Blue Cross Blue Shield	$11 - $32	107%
Champva [11001]	$11	107%
Commonwealth Care Mcr [10115]	$11	107%
Fallon Mcr Supp [20202]	$11	107%
Harvard Pilgrim Mcr [10106]	$11	107%
Mgb Mcr [10124]	$11	107%
Senior Whole Health [10110]	$11	107%
Tufts Mcr [10112]	$11	107%
UnitedHealthcare	$11 - $104	107%
Correctional Care [11003]	$14 - $16	136%
Workers Compensation [20501]	$14	136%
Tufts Connectorcare [10507]	$18	174%
Tufts [11201]	$23	223%
Harvard Pilgrim [10701]	$24 - $29	233%
Wellpoint [11112]	$27	262%
Hne [11108]	$58	562%
First Health Network [11120]	$78	756%
Multiplan [11109]	$78	756%
Fallon Connectorcare [10503]	$82	795%
Connecticare [11105]	$104	1008%
Fallon Carelon Hlth [28]	$104	1008%
Fallon Mcaid Carelon Hlth [29]	$104	1008%
Grants [20507]	$104	1008%
Hsno/Free Care [10801]	$294	2849%

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 $104.
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 UMass Memorial Healthalliance Hospitals 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.