CMS Price Transparency Data

Culture, blood

Facility: Mercy Hospital Carthage

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $93
Cash Discount Price: $111
vs. Medicare Baseline: 9.01x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Mercy Hospital Carthage is $93. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 9.01x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$93

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: $111 (1076%)

Insurance Median: $93 (901%)

Cash: $111 (1076% of Medicare)

Ins. Median: $93 (901% 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 901% of the Medicare baseline (a markup of 801%). 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	$9 - $151	87%
Blue Cross Blue Shield	$9 - $47	87%
Humana	$9 - $51	87%
Medicaid / KanCare	$9 - $93	87%
Medicare (plans)	$11 - $50	107%
United Medical Resources Contracted [320454]	$14 - $153	136%
UnitedHealthcare	$14 - $148	136%
Cherokee Nation Health Serv Contracted [320066]	$47	455%
Cigna	$47 - $153	455%
Cross Timbers Hospice [20098]	$47	455%
Dept Of Veteran Affairs Contracted [320106]	$47	455%
Elara Caring Aspire Hospice [20433]	$47	455%
Globalhealth Contracted [320145]	$47	455%
Halo Hcr Inc Hospice Contracted [320432]	$47	455%
Halo Hcr Inc Hospice [20432]	$47	455%
Indian Health Service Contracted [320198]	$47	455%
Kindful Hospice Contracted [320434]	$47	455%
Kindful Hospice [20434]	$47	455%
Medical Associates Health Contracted [320444]	$47	455%
Mercy Hospice Okc [20252]	$47	455%
Mercy Mgd Behavioral Health Contracted [320259]	$47	455%
Pace Of The Ozarks Contracted [320518]	$47	455%
Provider Partners Health Plans Contracted [320450]	$47	455%
Qual Choice Contracted [320325]	$47	455%
Tricare	$47	455%
Point C Contracted [320238]	$60 - $153	581%
Health Systems Inc Contracted [320174]	$73	707%
Insurance System Inc Contracted [320465]	$73	707%
Administrative Payor Contracted [320005]	$76	736%
Centivo Contracted [320505]	$78	756%
Healthscope Contracted [320182]	$89	862%
Ambetter / Centene	$93	901%
Home State Health Plan Contracted [320187]	$93	901%
Novasys Contracted [320285]	$93	901%
Benefit Management Contracted [320052]	$102 - $148	988%
Auxiant Contracted [320462]	$110 - $144	1066%
Healthlink Contracted [320179]	$110 - $158	1066%
Preferred Health Plan Contracted [320522]	$110	1066%
Workers Comp [20426]	$136 - $170	1318%
90 Degree Benefits Contracted [320436]	$144	1395%
Aither Health Contracted [320449]	$144	1395%
Ebms Contracted [320493]	$144	1395%
Edison Health Solutions Contracted [320502]	$144	1395%
Imagine 360 Contracted [320494]	$144	1395%
Mercy Benefit Admin Contracted [320251]	$144 - $153	1395%
Reflect Health Contracted [320492]	$144	1395%
Show-Me Health Administrators Contracted [320483]	$144	1395%
Yuzu Health Contracted [320521]	$144	1395%
Medica Contracted [320239]	$147	1424%
Evolutions Health Care Contracted [320124]	$148	1434%
First Health Contracted [320128]	$148	1434%
Multiplan Contracted [320270]	$148	1434%
Private Health Care Systems Contracted [320320]	$148	1434%
American Healthcare Alliance Contracted [320020]	$153	1483%
Ppo Plus Contracted [320310]	$153	1483%
Usa Managed Care Org Contracted [320429]	$153	1483%

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 $111.
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 Carthage 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.