CMS Price Transparency Data

Culture, blood

Facility: Coteau Des Prairies Health Care System

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $96
Cash Discount Price: $149
vs. Medicare Baseline: 9.30x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Coteau Des Prairies Health Care System is $96. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $149. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 9.30x the Medicare baseline. Located in 205 Orchard Dr, Sisseton, SD.

Cash / Self-Pay

$149

Average discount available for prompt cash payment at this facility.

Insurance Median

$96

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: $149 (1444%)

Insurance Median: $96 (930%)

Cash: $149 (1444% of Medicare)

Ins. Median: $96 (930% 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 930% of the Medicare baseline (a markup of 830%). 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
Humana	$49	475%
Indian Health Service	$49	475%
Medica	$49 - $89	475%
UnitedHealthcare	$49 - $103	475%
Primwest Health	$52	504%
Blue Cross Blue Shield	$112 - $115	1085%
Avera Health Plan	$142	1376%
Sanford Health Plan	$145	1405%

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 $149.
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 Coteau Des Prairies Health Care System 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.