CMS Price Transparency Data

Culture, blood

Facility: Mercy Hospital Aurora

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $217
Cash Discount Price: $166
vs. Medicare Baseline: 21.03x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Mercy Hospital Aurora is $217. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $166. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 21.03x the Medicare baseline. Located in 500 Porter Avenue, Aurora, MO.

Cash / Self-Pay

$166

Average discount available for prompt cash payment at this facility.

Insurance Median

$217

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: $166 (1609%)

Insurance Median: $217 (2103%)

Cash: $166 (1609% of Medicare)

Ins. Median: $217 (2103% 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 2103% of the Medicare baseline (a markup of 2003%). 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
Medicaid / KanCare	$9 - $130	87%
Medicare (plans)	$11 - $76	107%
Blue Cross Blue Shield	$14 - $256	136%
UnitedHealthcare	$14 - $243	136%
Aetna	$73 - $228	707%
Cherokee Nation Health Serv Contracted [320066]	$73	707%
Cigna	$73 - $218	707%
Cross Timbers Hospice [20098]	$73	707%
Elara Caring Aspire Hospice [20433]	$73	707%
Globalhealth Contracted [320145]	$73	707%
Halo Hcr Inc Hospice Contracted [320432]	$73	707%
Halo Hcr Inc Hospice [20432]	$73	707%
Humana	$73 - $218	707%
Indian Health Service Contracted [320198]	$73	707%
Kindful Hospice Contracted [320434]	$73	707%
Kindful Hospice [20434]	$73	707%
Medical Associates Health Contracted [320444]	$73	707%
Mercy Hospice Okc [20252]	$73	707%
Mercy Mgd Behavioral Health Contracted [320259]	$73	707%
Pace Of The Ozarks Contracted [320518]	$73	707%
Provider Partners Health Plans Contracted [320450]	$73	707%
Qual Choice Contracted [320325]	$73	707%
Dept Of Veteran Affairs Contracted [320106]	$74	717%
Tricare	$74	717%
Healthscope Contracted [320182]	$94	911%
Centivo Contracted [320505]	$102	988%
Administrative Payor Contracted [320005]	$115	1114%
Ambetter / Centene	$130	1260%
Home State Health Plan Contracted [320187]	$130	1260%
Novasys Contracted [320285]	$130	1260%
Healthlink Contracted [320179]	$166 - $230	1609%
Preferred Health Plan Contracted [320522]	$166	1609%
Health Systems Inc Contracted [320174]	$205	1986%
Insurance System Inc Contracted [320465]	$205	1986%
Point C Contracted [320238]	$205 - $218	1986%
Point C [20238]	$205	1986%
Workers Comp [20426]	$205 - $218	1986%
Medica Contracted [320239]	$217	2103%
90 Degree Benefits Contracted [320436]	$218	2112%
Aither Health Contracted [320449]	$218	2112%
American Healthcare Alliance Contracted [320020]	$218	2112%
Auxiant Contracted [320462]	$218	2112%
Benefit Management Contracted [320052]	$218	2112%
Ebms Contracted [320493]	$218	2112%
Edison Health Solutions Contracted [320502]	$218	2112%
Evolutions Health Care Contracted [320124]	$218	2112%
First Health Contracted [320128]	$218	2112%
Imagine 360 Contracted [320494]	$218	2112%
Mercy Benefit Admin Contracted [320251]	$218	2112%
Reflect Health Contracted [320492]	$218	2112%
Show-Me Health Administrators Contracted [320483]	$218	2112%
United Medical Resources Contracted [320454]	$218 - $225	2112%
Yuzu Health Contracted [320521]	$218	2112%
Usa Managed Care Org Contracted [320429]	$225	2180%
Multiplan Contracted [320270]	$243	2355%
Private Health Care Systems Contracted [320320]	$243	2355%

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 $166.
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 Mercy Hospital Aurora 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.