CMS Price Transparency Data

Culture, blood

Facility: Medstar Saint Mary's Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $87
Cash Discount Price: $86
vs. Medicare Baseline: 8.43x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Medstar Saint Mary's Hospital is $87. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 8.43x the Medicare baseline. Located in 25500 Point Lookout Road, Leonardtown, MD.

Cash / Self-Pay

$86

Average discount available for prompt cash payment at this facility.

Insurance Median

$87

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: $86 (833%)

Insurance Median: $87 (843%)

Cash: $86 (833% of Medicare)

Ins. Median: $87 (843% 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 843% of the Medicare baseline (a markup of 743%). 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	$87	843%
Amerigroup	$87	843%
Amerihealth Caritas District Of Columbia	$87	843%
Carefirst Advantage Inc	$87	843%
Carefirst Blue Choice Inc	$87	843%
Cigna	$87	843%
First Health	$87	843%
Hscsn	$87	843%
Humana	$87	843%
Kaiser Permanente	$87	843%
Magellan Behavioral Health Inc	$87	843%
Mamsi	$87	843%
Medstar Family Choice	$87	843%
Medstar Family Choice Inc	$87	843%
Ncppo Healthlink Ppo	$87	843%
Pfc	$87	843%
Private Healthcare Systems (Phcs)	$87	843%
Tricare	$87	843%
United Behavioral Health Inc	$87	843%
UnitedHealthcare	$87	843%

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 $86.
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 Medstar Saint Mary's 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.