CMS Price Transparency Data

Culture, blood

Facility: Excela Health - Frick Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 87040
  • Insurance Median: $12
  • Cash Discount Price: $16
  • vs. Medicare Baseline: 1.16x Medicare
The contracted insurance negotiated median rate for a Culture, blood at Excela Health - Frick Hospital is $12. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 1.16x the Medicare baseline. Located in 508 South Church Street, Mount Pleasant, PA.
Cash / Self-Pay
$16

Average discount available for prompt cash payment at this facility.

Insurance Median
$12

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: $16 (155%)
Insurance Median: $12 (116%)
Cash: $16 (155% of Medicare)
Ins. Median: $12 (116% 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.

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
Highmark Advantage Community Blue $10 97%
Va $10 97%
Aetna $11 - $24 107%
American Health Plan Of Pa $11 107%
Amerihealth Caritas $11 - $18 107%
Cigna $11 - $15 107%
Devoted $11 107%
Geisinger $11 - $17 107%
Health Partners Plan $11 107%
Highmark Wholecare $11 - $17 107%
Humana $11 107%
Martin'S Point $11 107%
Pa Health And Wellness $11 - $18 107%
Peak Health $11 - $24 107%
Provider Network Of America $11 - $21 107%
Provider Plan Partners Plan $11 107%
The Health Plan Of West Virginia $11 - $24 107%
United $11 107%
Upmc $11 - $18 107%
Upmc For Kids Chip $11 107%
Highmark Children'S Health Insurance Program $12 116%
UnitedHealthcare $12 116%
Upmc Health Plan $12 - $50 116%
Ambetter / Centene $13 126%
Health Partners Plans $14 136%
Highmark $14 - $23 136%
Velocity $15 145%
Community Blue $20 194%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 508 South Church Street, Mount Pleasant, PA 15666
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Other
  • Hospital Type: Acute Care Hospitals