CMS Price Transparency Data
Culture, blood
Facility: Saint Alphonsus Medical Center Ontario
Billing Code: 87040 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 87040
- Insurance Median: $63
- Cash Discount Price: $137
- vs. Medicare Baseline: 6.10x Medicare
The contracted insurance negotiated median rate for a Culture, blood at Saint Alphonsus Medical Center Ontario is $63. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $137. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 6.10x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.
Cash / Self-Pay
$137
Average discount available for prompt cash payment at this facility.
Insurance Median
$63
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: $137 (1328%)
Insurance Median: $63 (610%)
Cash: $137 (1328% of Medicare)
Ins. Median: $63 (610% 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 610% of the Medicare baseline (a markup of 510%). 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 |
|---|---|---|
| Medicaid / KanCare | $7 - $63 | 68% |
| Aetna | $10 - $199 | 97% |
| Blue Cross Blue Shield | $10 - $178 | 97% |
| Medicare (plans) | $10 - $11 | 97% |
| UnitedHealthcare | $10 - $202 | 97% |
| American Health Advantage Of Idaho | $11 | 107% |
| Healthnet | $11 | 107% |
| Healthcare Management Admin | $17 | 165% |
| Blue Benefit Administrators Of Massachusetts | $18 | 174% |
| Blue Care Network | $18 | 174% |
| Blue Distinction Transplant | $18 | 174% |
| Blue Shield - Ca | $18 | 174% |
| Blue Shield - Id (Regence) | $18 | 174% |
| Blue Shield - Ny Highmark Northeastern | $18 | 174% |
| Blue Shield - Ny Highmark Western | $18 | 174% |
| Blue Shield - Pa (Highmark) | $18 | 174% |
| Blue Shield - Wa (Regence) | $18 | 174% |
| Moda Health | $20 - $204 | 194% |
| Webtpa | $27 - $189 | 262% |
| Selecthealth | $39 - $189 | 378% |
| Ada County Jail Inmate Ins | $63 | 610% |
| Ambetter / Centene | $63 | 610% |
| Amish Mennonite | $63 | 610% |
| Bcccp-Michigan | $63 | 610% |
| Bccp | $63 | 610% |
| Bmc Healthnet | $63 | 610% |
| Breast Grant-Connecticut | $63 | 610% |
| California Health And Wellness | $63 | 610% |
| Cardinal Innovations Lme | $63 | 610% |
| Care Oregon Ohp | $63 | 610% |
| Cencal Health Plan | $63 | 610% |
| Cenpatico | $63 | 610% |
| Centurion Of Idaho | $63 | 610% |
| Chhuny | $63 | 610% |
| Childrens Comm Health Plan | $63 | 610% |
| Childrens Medical Services Title 19 | $63 | 610% |
| Cigna | $63 - $197 | 610% |
| Community Benefit Health | $63 | 610% |
| Community Care Behavorial Health | $63 | 610% |
| Community Health Choice | $63 | 610% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $63 | 610% |
| Dean Wi Badgercare | $63 | 610% |
| Delaware First Health | $63 | 610% |
| Delta Dental Nj | $63 | 610% |
| Dph Tb Program | $63 | 610% |
| Dscc | $63 | 610% |
| Eastpointe Lme | $63 | 610% |
| Family Health Network | $63 | 610% |
| Freedom First Healthcare | $63 | 610% |
| Ghc Scw Wi Badgercare | $63 | 610% |
| Harbor Health | $63 | 610% |
| Health Safety Net | $63 | 610% |
| Healthy Blue Ne | $63 | 610% |
| Hennepin Health | $63 | 610% |
| Humana | $63 - $185 | 610% |
| Id County Ada | $63 | 610% |
| Id County Canyon | $63 | 610% |
| Id County Cat Fund | $63 | 610% |
| Id County Payette | $63 | 610% |
| Idaho Womens Health Check | $63 | 610% |
| Indiana Breast Cervical Cancer | $63 | 610% |
| Inland Empire Health Plan | $63 | 610% |
| Intercommunity Health Ohp | $63 | 610% |
| Iowa Total Care | $63 | 610% |
| Jai Medical System | $63 | 610% |
| Kern Family Health Plan | $63 | 610% |
| Keystone First | $63 | 610% |
| Keystone First Chip | $63 | 610% |
| La Care Health Plan | $63 | 610% |
| Lakeland Care Inc | $63 | 610% |
| Managed Health Services - Indiana | $63 | 610% |
| Maryland Breast & Cervical Program | $63 | 610% |
| Maryland Healthy Smiles - Scion Dental | $63 | 610% |
| Maryland Physicians Care | $63 | 610% |
| Massachusetts Behavioral Health Partnership | $63 | 610% |
| Mdwise | $63 | 610% |
| Medi-Cal | $63 | 610% |
| Medi-Cal Healthnet | $63 | 610% |
| Medstar Dc Healthy Family | $63 | 610% |
| Medstar Md Health Choice | $63 | 610% |
| Mo Home State Health Plan | $63 | 610% |
| Molina Centennial Care | $63 | 610% |
| Nascentia Health Options | $63 | 610% |
| Nebraska Total Care | $63 | 610% |
| New York Cancer Services Program | $63 | 610% |
| Nextlevel Health | $63 | 610% |
| Oregon Screenwise | $63 | 610% |
| Pace Of Southwest Michigan | $63 | 610% |
| Paramount Advantage | $63 | 610% |
| Parkland Community Health Plan | $63 | 610% |
| Partners Behavioral Lme | $63 | 610% |
| Peach State Healthplan | $63 | 610% |
| Presbyterian Centennial Care | $63 | 610% |
| Prestige Health Choice | $63 | 610% |
| Priority Partners | $63 | 610% |
| Rx 340B Pass Along | $63 | 610% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $63 | 610% |
| Rx Medi-Cal | $63 | 610% |
| Rx Meridian Rx | $63 | 610% |
| Sandhills Center Lme | $63 | 610% |
| Screening For Life | $63 | 610% |
| Sunshine State Health Plan | $63 | 610% |
| Superior Health | $63 | 610% |
| Tenncare | $63 | 610% |
| Texas Children'S Health Plan | $63 | 610% |
| Trillium Community Ohp | $63 | 610% |
| Tufts Health Public Plans | $63 | 610% |
| Vaya Health Lme | $63 | 610% |
| Wellsense Health Plan | $63 | 610% |
| Wi Womens Wellness | $63 | 610% |
| Mountain Health Co-Op | $126 | 1221% |
| Pacificsource Health Plans | $126 - $197 | 1221% |
| Allegiance | $160 | 1550% |
| Correctional Health Partners | $164 | 1589% |
| Columbia Health Network | $168 | 1628% |
| Allied National Global Care | $189 | 1831% |
| Asrm - Reliance Standard Life Insurance | $189 | 1831% |
| Christian Care Ministry | $189 | 1831% |
| Dean Health | $189 | 1831% |
| Fallon Health | $189 | 1831% |
| Family Life Insurance Company | $189 | 1831% |
| First Choice Health | $189 | 1831% |
| Ghc Scw | $189 | 1831% |
| International Benefit Administrators | $189 | 1831% |
| Lifetime Benefit Solutions | $189 | 1831% |
| Manhattan Life | $189 | 1831% |
| Pai | $189 | 1831% |
| Pan-American Life | $189 | 1831% |
| Paramount Hmo | $189 | 1831% |
| Phcs | $189 | 1831% |
| Trinity Health Share | $189 | 1831% |
| Lifewise | $195 | 1890% |
| Priority Health | $197 | 1909% |
| Allied Benefit Systems | $199 | 1928% |
| Ameriben | $199 | 1928% |
| Asr Health Benefits | $199 | 1928% |
| Christian Brother Services | $199 | 1928% |
| Geha | $199 - $202 | 1928% |
| Healthez | $199 | 1928% |
| Luminare Health (Detroit) | $199 | 1928% |
| Rural Carrier Health Benefit Plan | $199 | 1928% |
| First Health | $200 | 1938% |
| Medi Share | $200 | 1938% |
| Providence | $200 | 1938% |