CMS Price Transparency Data

Culture, blood

Facility: Saint Clare's Hospital/ Denville Campus

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $10
Cash Discount Price: $10
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Saint Clare's Hospital/ Denville Campus is $10. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 0.97x the Medicare baseline. Located in 25 Pocono Road, Denville, NJ.

Cash / Self-Pay

$10

Average discount available for prompt cash payment at this facility.

Insurance Median

$10

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: $10 (97%)

Insurance Median: $10 (97%)

Cash: $10 (97% of Medicare)

Ins. Median: $10 (97% 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.

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
UnitedHealthcare	$6 - $10	58%
Humana	$8	78%
Aetna	$10 - $22	97%
Amerihealth	$10	97%
Clover Health	$10	97%
Horizon	$10 - $56	97%
Medicare (plans)	$10	97%
Tricare	$10	97%
Wellcare	$10 - $14	97%
Wellpoint Amerigroup	$10	97%
Ally-Align (Fka Spartan Health Plan)	$11	107%
Fairprice Healthcare Holdings - Fphh	$12	116%
Employer Direct Healthcare	$14	136%
Cigna	$15	145%
Brighton Health Plan Solutions (Fka Magnacare)	$16	155%
Coventry	$21	203%

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 $10.
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 Saint Clare's Hospital/ Denville Campus 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.