CMS Price Transparency Data

Culture, blood

Facility: Punxsutawney Area Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $11
Cash Discount Price: $32
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Punxsutawney Area Hospital is $11. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 1.07x the Medicare baseline. Located in 81 Hillcrest Drive, Punxsutawney, PA.

Cash / Self-Pay

$32

Average discount available for prompt cash payment at this facility.

Insurance Median

$11

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: $32 (310%)

Insurance Median: $11 (107%)

Cash: $32 (310% of Medicare)

Ins. Median: $11 (107% 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.

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
UnitedHealthcare	$4 - $33	39%
Cigna	$5 - $49	48%
Highmark Wholecare	$6 - $15	58%
Highmark	$7 - $28	68%
Tricare	$9	87%
Aetna	$10 - $23	97%
Amerihealth Caritas	$10 - $14	97%
Geisinger Health Plan	$10 - $18	97%
Humana	$10	97%
United Mine Workers Of America	$10	97%
Upmc Health Plan	$10 - $57	97%
Ambetter / Centene	$11 - $19	107%
Pa Health And Wellness Commercial	$13 - $21	126%
Geisinger	$14 - $29	136%
Pa Workers Compensation	$82	795%

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 $32.
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 Punxsutawney Area 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.