CMS Price Transparency Data

Culture, blood

Facility: Mercy Hospital Lincoln

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $118
Cash Discount Price: $164
vs. Medicare Baseline: 11.43x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Mercy Hospital Lincoln is $118. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $164. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 11.43x the Medicare baseline. Located in 1000 East Cherry Street, Troy, MO.

Cash / Self-Pay

$164

Average discount available for prompt cash payment at this facility.

Insurance Median

$118

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: $164 (1589%)

Insurance Median: $118 (1143%)

Cash: $164 (1589% of Medicare)

Ins. Median: $118 (1143% 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 1143% of the Medicare baseline (a markup of 1043%). 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
Medicare (plans)	$10 - $252	97%
United Medical Resources Contracted [320454]	$10	97%
UnitedHealthcare	$10 - $59	97%
Blue Cross Blue Shield	$12 - $120	116%
Medicaid / KanCare	$13 - $116	126%
Cigna	$14 - $63	136%
Healthlink Contracted [320179]	$15 - $214	145%
Aetna	$38 - $165	368%
Tricare	$54	523%
American Health Advantage Of Mo Mcr [10473]	$59	572%
Cherokee Nation Health Serv Contracted [320066]	$59	572%
Cross Timbers Hospice [20098]	$59	572%
Dept Of Veteran Affairs Contracted [320106]	$59	572%
Elara Caring Aspire Hospice Contracted [320433]	$59	572%
Elara Caring Aspire Hospice [20433]	$59	572%
Globalhealth Contracted [320145]	$59	572%
Halo Hcr Inc Hospice Contracted [320432]	$59	572%
Halo Hcr Inc Hospice [20432]	$59	572%
Humana	$59 - $227	572%
Indian Health Service Contracted [320198]	$59	572%
Kindful Hospice Contracted [320434]	$59	572%
Kindful Hospice [20434]	$59	572%
Mercy Hospice Okc [20252]	$59	572%
Pace Of The Ozarks Contracted [320518]	$59	572%
Provider Partners Health Plans Contracted [320450]	$59	572%
Qual Choice Contracted [320325]	$59	572%
Centivo Contracted [320505]	$91	882%
Medica Contracted [320239]	$106	1027%
Ambetter / Centene	$116	1124%
Home State Health Plan Contracted [320187]	$116	1124%
Novasys Contracted [320285]	$116	1124%
Hope Trust Contracted [320488]	$125	1211%
Health Choices Contracted [320448]	$151	1463%
Health Choices [20448]	$151	1463%
Medical Associates Health Contracted [320444]	$151	1463%
First Health Contracted [320128]	$165 - $189	1599%
Mercy Mgd Behavioral Health Contracted [320259]	$189	1831%
Multiplan Contracted [320270]	$189	1831%
Private Health Care Systems Contracted [320320]	$189	1831%
Workers Comp [20426]	$189 - $202	1831%
Aither Health Contracted [320449]	$214	2074%
Aither Health [20449]	$214	2074%
Auxiant Contracted [320462]	$214	2074%
Ebms Contracted [320493]	$214	2074%
Edison Health Solutions Contracted [320502]	$214	2074%
Federal Medical Center Contracted [320127]	$214	2074%
Imagine 360 Contracted [320494]	$214	2074%
Insurance System Inc Contracted [320465]	$214	2074%
Mercy Benefit Admin Contracted [320251]	$214	2074%
Mercy Benefit Admin [20251]	$214	2074%
Point C Contracted [320238]	$214	2074%
Preferred Health Plan Contracted [320522]	$214	2074%
Reflect Health Contracted [320492]	$214	2074%
Show-Me Health Administrators Contracted [320483]	$214	2074%
Tri State Healthcare Coalition Contracted [320379]	$214	2074%
Yuzu Health Contracted [320521]	$214	2074%

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 $164.
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 Lincoln 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.