CMS Price Transparency Data

Culture, blood

Facility: Garnet Health Medical Center

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $11
Cash Discount Price: $98
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Garnet Health Medical Center is $11. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $98. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 1.07x the Medicare baseline. Located in 707 East Main Street, Middletown, NY.

Cash / Self-Pay

$98

Average discount available for prompt cash payment at this facility.

Insurance Median

$11

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: $98 (950%)

Insurance Median: $11 (107%)

Cash: $98 (950% of Medicare)

Ins. Median: $11 (107% 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
Cigna	$9	87%
Aetna	$10 - $11	97%
UnitedHealthcare	$10	97%
Fidelis	$11	107%
Local 1199	$11	107%
Wellcare	$11	107%
Rojw	$18	174%
Northwell Direct	$21	203%
Blue Cross Blue Shield	$25	242%
Geisinger Health Plan	$26	252%
Mvp	$34	329%

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 $98.
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 Garnet Health Medical Center 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.