CMS Price Transparency Data

Culture, blood

Facility: Southcoast Hospitals Group

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $12
Cash Discount Price: $51
vs. Medicare Baseline: 1.16x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Southcoast Hospitals Group is $12. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $51. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 1.16x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$51

Average discount available for prompt cash payment at this facility.

Insurance Median

$12

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: $51 (494%)

Insurance Median: $12 (116%)

Cash: $51 (494% of Medicare)

Ins. Median: $12 (116% 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
Aetna	$10 - $77	97%
Blue Cross Blue Shield	$10 - $21	97%
Evercare [1010304]	$10	97%
Medicare (plans)	$10 - $25	97%
Tufts Senior Care Options [1010315]	$10	97%
UnitedHealthcare	$10 - $12	97%
Wellsense Health Plan Senior Care Options [1020208	$10	97%
Commonwealth Care Alliance [1080501]	$11	107%
Eternal Health [1010322]	$11	107%
Tufts Health Public Plans [1010213]	$11	107%
Fallon [1000114]	$14	136%
Harvard Pilgrim [1010602]	$22	213%
Wellsense Health Plan Clarity Connectorcare & Meta	$22	213%
Cigna	$23	223%
Wellpoint [1000102]	$32	310%
Tufts [1010701]	$42	407%
Mass General Brigham Health Plan Commercial [10122	$57	552%
Mass General Brigham Health Plan Connectorcare [10	$57	552%
Group Insurance Service Center [1013001]	$61	591%
Innovative Health Plan [1025001]	$61	591%
Priority Health [1015001]	$61	591%
PHCS [1000125]	$66	640%
First Health [1000130]	$77	746%

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 $51.
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 Southcoast Hospitals Group 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.