CMS Price Transparency Data
Culture, blood
Facility: Mount Carmel East & West
Billing Code: 87040 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 87040
- Insurance Median: $90
- Cash Discount Price: $2,249
- vs. Medicare Baseline: 8.72x Medicare
The contracted insurance negotiated median rate for a Culture, blood at Mount Carmel East & West is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,249. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 8.72x the Medicare baseline. Located in 6001 East Broad Street, Columbus, OH.
Cash / Self-Pay
$2,249
Average discount available for prompt cash payment at this facility.
Insurance Median
$90
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: $2,249 (21793%)
Insurance Median: $90 (872%)
Cash: $2,249 (21793% of Medicare)
Ins. Median: $90 (872% 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 872% of the Medicare baseline (a markup of 772%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicare (plans) | $9 - $543 | 87% |
| Aetna | $10 - $532 | 97% |
| Blue Benefit Administrators Of Massachusetts | $10 - $1,965 | 97% |
| Blue Care Network | $10 - $1,965 | 97% |
| Blue Cross Blue Shield | $10 - $1,965 | 97% |
| Blue Distinction Transplant | $10 - $1,965 | 97% |
| Blue Shield - Ca | $10 - $1,965 | 97% |
| Blue Shield - Id (Regence) | $10 - $1,965 | 97% |
| Blue Shield - Ny Highmark Northeastern | $10 - $1,965 | 97% |
| Blue Shield - Ny Highmark Western | $10 - $1,965 | 97% |
| Blue Shield - Pa (Highmark) | $10 - $1,965 | 97% |
| Blue Shield - Wa (Regence) | $10 - $1,965 | 97% |
| Hospice Mount Carmel | $10 - $517 | 97% |
| Oscar | $10 - $853 | 97% |
| Rural Carrier Health Benefit Plan | $10 | 97% |
| UnitedHealthcare | $10 - $1,918 | 97% |
| The Health Plan | $11 - $527 | 107% |
| Medical Mutual | $19 - $1,798 | 184% |
| Enterprise Group Planning | $20 - $998 | 194% |
| Custom Design Benefits | $22 - $1,080 | 213% |
| Quality Care Partners | $23 - $1,168 | 223% |
| Western & Southern Financial Group | $26 - $1,798 | 252% |
| American Postal Workers Secondary | $43 | 417% |
| Cigna | $43 | 417% |
| Health Partners | $43 | 417% |
| Healthgram | $43 | 417% |
| Mvp | $43 | 417% |
| Priority Health | $43 | 417% |
| Geha | $69 - $1,918 | 669% |
| Gravie Admin Services | $86 | 833% |
| Healthez | $86 | 833% |
| Meritain | $86 | 833% |
| Webtpa | $86 | 833% |
| Access Health | $90 | 872% |
| Acclaim | $90 | 872% |
| Administrative Concepts | $90 | 872% |
| Allegeant | $90 | 872% |
| Allied Benefit Systems | $90 | 872% |
| American Family | $90 | 872% |
| American Healthcare Alliance | $90 | 872% |
| American National | $90 | 872% |
| American Republic | $90 | 872% |
| Amerihealth | $90 | 872% |
| Aultcare | $90 | 872% |
| Automated Benefit Services | $90 | 872% |
| Auxiant | $90 | 872% |
| Benefit Administrative Systems,Llc | $90 | 872% |
| Boon Chapman | $90 | 872% |
| Cam Administrative Services | $90 | 872% |
| Christian Brother Services | $90 | 872% |
| Christian Brothers Holy Cross | $90 | 872% |
| Claimchoice Adminstrators | $90 | 872% |
| Comprehensive Benefits | $90 | 872% |
| Continental Life Insurance | $90 | 872% |
| Coventry | $90 | 872% |
| Custom Benefit Administrators | $90 | 872% |
| Cypress Benefit Administrators | $90 | 872% |
| Employee Benefit Concepts | $90 | 872% |
| Employee Benefit Management | $90 | 872% |
| Forest County Potawatomi | $90 | 872% |
| Freedom Life Insurance Company | $90 | 872% |
| Group Administrators | $90 | 872% |
| Group Marketing Services | $90 | 872% |
| Group Pension Administrators | $90 | 872% |
| Guardian | $90 | 872% |
| Health America | $90 | 872% |
| Health Choices | $90 | 872% |
| Healthcare Management Admin | $90 | 872% |
| Insight | $90 | 872% |
| Intercare | $90 | 872% |
| Jfp Benefit Management | $90 | 872% |
| Jp Farley Corporation | $90 | 872% |
| Key Benefit Administrator | $90 | 872% |
| Liberty Union Life Assurance Co | $90 | 872% |
| Lucent Health | $90 | 872% |
| Luminare Health | $90 | 872% |
| Magnacare | $90 | 872% |
| Medcost | $90 | 872% |
| Mutual Health Services | $90 | 872% |
| Mutual Of Omaha | $90 | 872% |
| Ncas | $90 | 872% |
| Nippon Life Ins | $90 | 872% |
| Nova | $90 | 872% |
| Painters Union Insurance Fund | $90 | 872% |
| Physicians Mutual | $90 | 872% |
| Plumbers Local 98 Insurance Fund | $90 | 872% |
| Prairie States | $90 | 872% |
| Preferred One | $90 | 872% |
| Primary Physician Care | $90 | 872% |
| Professional Benefit Administrators | $90 | 872% |
| Secureone Preferred United Plans | $90 | 872% |
| Siho Insurance Services | $90 | 872% |
| Sisco Benefits | $90 | 872% |
| The Loomis Company | $90 | 872% |
| Trustmark Small Business Benefits | $90 | 872% |
| U Of M Health Plan | $90 | 872% |
| Unicare | $90 | 872% |
| Unified Group Services | $90 | 872% |
| Us Health And Life | $90 | 872% |
| Valenz | $90 | 872% |
| Varipro | $90 | 872% |
| Wps | $90 | 872% |
| Humana | $98 - $192 | 950% |
| First Health | $101 | 979% |
| Medben | $115 - $144 | 1114% |
| Consociate | $117 | 1134% |
| Health Ohio Network | $117 | 1134% |
| Caresource | $140 | 1357% |
| Healthlink Inc | $144 | 1395% |
| Medical Benefits Mutual | $144 | 1395% |
| Ohio Health Choice | $144 | 1395% |
| Ohio Ppo Connect | $144 | 1395% |
| Medi Share | $153 | 1483% |
| Multiplan | $153 | 1483% |
| Phcs | $153 | 1483% |
| Philadelphia American Life Insurance | $153 | 1483% |
| Ameriben | $154 | 1492% |
| Luminare Health (Detroit) | $154 | 1492% |
| Ohiohealthy | $154 | 1492% |
| Osu Not Independent Choice | $154 | 1492% |
| Twin Valley Psychiatric | $154 | 1492% |
| Health Smart | $163 | 1579% |
| Bccp | $192 | 1860% |
| Medicaid / KanCare | $192 | 1860% |
| Optima Health | $192 | 1860% |
| Crime Victim Assistance | $632 | 6124% |
| Ohio Safe Program | $632 | 6124% |