CMS Price Transparency Data

Culture, blood

Facility: UMass Memorial Health - Harrington Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $18
Cash Discount Price: $91
vs. Medicare Baseline: 1.74x Medicare

The contracted insurance negotiated median rate for a Culture, blood at UMass Memorial Health - Harrington Hospital is $18. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $91. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 1.74x the Medicare baseline. Located in 100 South Street, Southbridge, MA.

Cash / Self-Pay

$91

Average discount available for prompt cash payment at this facility.

Insurance Median

$18

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: $91 (882%)

Insurance Median: $18 (174%)

Cash: $91 (882% of Medicare)

Ins. Median: $18 (174% 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
Masshealth [20302]	$9	87%
Medicaid / KanCare	$9 - $10	87%
Cigna	$10 - $65	97%
Institution [10406]	$10	97%
Mgb Mcr [10124]	$10	97%
Tufts Us Family [11203]	$10	97%
Aetna	$11 - $91	107%
Blue Cross Blue Shield	$11 - $32	107%
Commonwealth Care Alliance [10103]	$11	107%
Fallon Mcr Supp [20202]	$11	107%
Fallon Mcr [10105]	$11	107%
Senior Whole Health [10110]	$11	107%
Tufts Mcr [10112]	$11	107%
UnitedHealthcare	$11 - $91	107%
Champva [11001]	$12	116%
Workers Compensation [20501]	$14	136%
Tufts Connectorcare [10507]	$18	174%
Wellpoint [11112]	$27	262%
Harvard Pilgrim [10701]	$38 - $46	368%
Hne [11108]	$59	572%
Tufts [11201]	$65	630%
First Health Network [11120]	$68	659%
Evernorth Behavioral Health [27]	$73	707%
Fallon Connectorcare [10503]	$82	795%
Connecticare [11105]	$91	882%
Fallon Carelon Hlth [28]	$91	882%
Fallon Mcaid Carelon Hlth [29]	$91	882%
Grants [20507]	$91	882%
Masshealth Mcd Mbhp [38]	$91	882%
Wellsense Mcaid Carelon Hlth [21]	$91	882%
Hsno/Free Care [10801]	$681	6599%

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 $91.
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 Health - Harrington 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.