CMS Price Transparency Data

Culture, blood

Facility: Portsmouth Regional Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $54
Cash Discount Price: $499
vs. Medicare Baseline: 5.23x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Portsmouth Regional Hospital is $54. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $499. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 5.23x the Medicare baseline. Located in 333 Borthwick Ave, Portsmouth, NH.

Cash / Self-Pay

$499

Average discount available for prompt cash payment at this facility.

Insurance Median

$54

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: $499 (4835%)

Insurance Median: $54 (523%)

Cash: $499 (4835% of Medicare)

Ins. Median: $54 (523% 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 523% of the Medicare baseline (a markup of 423%). 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
Amerihealth Caritas	$9	87%
Well Sense Health Plan	$9	87%
Aetna	$10 - $316	97%
Humana	$10	97%
Martin'S Point Health	$10 - $11	97%
United Behavioral Health	$10	97%
United Va Ccn	$10	97%
Blue Cross Blue Shield	$11 - $221	107%
Cigna	$11 - $54	107%
Evernorth Behavioral Health	$11	107%
Sierra Military Health	$11	107%
United	$11 - $329	107%
Ambetter / Centene	$18	174%
Harvard Pilgrim	$39 - $214	378%
Maine Community Health	$156 - $264	1512%
Tufts Health Plan	$188 - $285	1822%
Mvp Health Plan	$349	3382%
Corvel	$359	3479%
Evernorth	$399	3866%
Mutual Of Omaha	$399	3866%
Multiplan	$404	3915%
First Health	$454	4399%
Healthcare Value Mgmt	$454	4399%
Oxford Health Plans	$474	4593%

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 $499.
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 Portsmouth Regional 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.