CMS Price Transparency Data

Culture, blood

Facility: Sanford Clear Lake Medical Center

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $101
Cash Discount Price: $98
vs. Medicare Baseline: 9.79x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Sanford Clear Lake Medical Center is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $98. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 9.79x the Medicare baseline. Located in 701 Third Avenue South, Clear Lake, SD.

Cash / Self-Pay

$98

Average discount available for prompt cash payment at this facility.

Insurance Median

$101

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: $98 (950%)

Insurance Median: $101 (979%)

Cash: $98 (950% of Medicare)

Ins. Median: $101 (979% 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 979% of the Medicare baseline (a markup of 879%). 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
Sanford Health Plan Align	$63	610%
Aetna	$68 - $107	659%
Health Partners	$68 - $92	659%
Medicare (plans)	$68	659%
Security Health Plan	$68	659%
Ucare	$68 - $108	659%
UnitedHealthcare	$68 - $103	659%
Wellmark Sd	$68	659%
Primewest	$70	678%
Sanford Health Plan	$85 - $114	824%
Blue Cross Blue Shield	$101 - $114	979%
Medica	$101 - $108	979%
Wellmark	$106 - $107	1027%
Cigna	$111	1076%
First Choice Health Network	$111	1076%
Healthez	$111	1076%
Multiplan	$111	1076%

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 $98.
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 Sanford Clear Lake 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.