CMS Price Transparency Data

Culture, blood

Facility: Clarion Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $23
Cash Discount Price: $48
vs. Medicare Baseline: 2.23x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Clarion Hospital is $23. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $48. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 2.23x the Medicare baseline. Located in One Hospital Drive, Clarion, PA.

Cash / Self-Pay

$48

Average discount available for prompt cash payment at this facility.

Insurance Median

$23

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: $48 (465%)

Insurance Median: $23 (223%)

Cash: $48 (465% of Medicare)

Ins. Median: $23 (223% 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 223% of the Medicare baseline (a markup of 123%). 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
Amerihealth	$10 - $15	97%
Cigna	$10 - $61	97%
Highmark	$10 - $41	97%
Highmark Community Blue	$10	97%
Martin'S Point - Usfhp	$10 - $43	97%
Medicare (plans)	$10	97%
Tricare	$10	97%
UnitedHealthcare	$10	97%
Aetna	$11 - $109	107%
American Health Plan	$11	107%
Devoted Health Plan	$11 - $49	107%
Gateway	$11 - $45	107%
Geisinger	$11	107%
Jefferson Health Plan	$11	107%
Pa Health & Wellness	$11	107%
The Health Plan	$11 - $24	107%
Upmc	$11 - $61	107%
Medicaid / KanCare	$14	136%
Highmark - Ind.& Managed Care	$17 - $41	165%
Peak Health	$24 - $85	233%
Devon	$38 - $92	368%

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 $48.
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 Clarion Hospital 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.