CMS Price Transparency Data

Culture, blood

Facility: Crystal Clinic Orthopaedic Center

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $223
Cash Discount Price: $114
vs. Medicare Baseline: 21.61x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Crystal Clinic Orthopaedic Center is $223. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $114. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 21.61x the Medicare baseline. Located in 444 North Main Street, Akron, OH.

Cash / Self-Pay

$114

Average discount available for prompt cash payment at this facility.

Insurance Median

$223

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: $114 (1105%)

Insurance Median: $223 (2161%)

Cash: $114 (1105% of Medicare)

Ins. Median: $223 (2161% 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 2161% of the Medicare baseline (a markup of 2061%). 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
Bc Mcr Adv	$10	97%
Summacare Mcr Adv	$10	97%
UnitedHealthcare	$10 - $320	97%
The Health Plan - All Plans	$21	203%
Aultcare - All Plans	$49	475%
Health Oh Network - All Plans	$91	882%
Ohio Health Choice - All Plans	$91	882%
Med Mutual Nas	$95	921%
Multiplan - All Plans	$100	969%
Healthsmart - All Plans	$129	1250%
Bc Pathway	$190	1841%
Cigna	$256	2481%
Bc Ohi/Ohii	$261	2529%
Summacare Comm - All Other Plans	$281	2723%
Med Mutual Medflex	$285	2762%
Bc Blue Access	$290	2810%
Bc Preferred	$290	2810%
Bc Trad - All Other Plans	$290	2810%
Med Mutual Aca	$324	3140%
Med Mutual Ppo/Pos/Hmo - All Other Plans	$356	3450%
Aetna	$360	3488%

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 $114.
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 Crystal Clinic Orthopaedic 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.