CMS Price Transparency Data

Culture, blood

Facility: Adena Fayette Medical Center

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $36
Cash Discount Price: $28
vs. Medicare Baseline: 3.49x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Adena Fayette Medical Center is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $28. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 3.49x the Medicare baseline. Located in 1430 Columbus Avenue, Washington Ch, OH.

Cash / Self-Pay

$28

Average discount available for prompt cash payment at this facility.

Insurance Median

$36

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: $28 (271%)

Insurance Median: $36 (349%)

Cash: $28 (271% of Medicare)

Ins. Median: $36 (349% 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 349% of the Medicare baseline (a markup of 249%). 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
Blue Cross Blue Shield	$5 - $37	48%
Aetna	$23 - $74	223%
Buckeye Community Health Plan	$23	223%
Humana	$23	223%
Medical Mutual Of Ohio	$23 - $42	223%
Medigold	$23	223%
Molina	$23	223%
Care Source	$24	233%
Molina Marketplace	$25	242%
United Medical Resources Ohcp	$35	339%
UnitedHealthcare	$35 - $36	339%
Cigna	$39	378%
Ohio Ppo Connect	$39	378%
The Health Plan	$39	378%
Care Source Just4Me	$42	407%
Medical Mutual Of Ohio Supermed	$42	407%
First Health	$44 - $74	426%
Ohio Health Choice	$45	436%
Multiplan/Private Healthcare Systems	$53	514%
Sidecar Health	$64	620%

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 $28.
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 Adena Fayette 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.