CMS Price Transparency Data

Culture, blood

Facility: St James Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $171
Cash Discount Price: Unavailable
vs. Medicare Baseline: 16.57x Medicare

The contracted insurance negotiated median rate for a Culture, blood at St James Hospital is $171. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 16.57x the Medicare baseline. Located in 400 S Clark St, Butte, MT.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$171

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%)

Insurance Median: $171 (1657%)

Ins. Median: $171 (1657% 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 1657% of the Medicare baseline (a markup of 1557%). 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
Humana	$11	107%
UnitedHealthcare	$11 - $272	107%
Coastal Administrative Services	$22	213%
Allegiance	$26 - $304	252%
First Choice Health	$50 - $288	484%
Ebms-Employee Benefit Mng	$57 - $288	552%
Pacificsource	$68 - $304	659%
Blue Cross Blue Shield	$82 - $320	795%
Cigna	$94 - $304	911%
Geha	$153 - $272	1483%
Mt Health Co-Op	$164 - $291	1589%
Aetna	$171 - $304	1657%
Interwest	$171 - $304	1657%
Meritain Health	$171 - $304	1657%

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 $X.
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 St James 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.