CMS Price Transparency Data

Culture, blood

Facility: Dekalb Community Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $10
Cash Discount Price: $90
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Dekalb Community Hospital is $10. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 0.97x the Medicare baseline. Located in 520 W Main St, Smithville, TN.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$10

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: $90 (872%)

Insurance Median: $10 (97%)

Cash: $90 (872% of Medicare)

Ins. Median: $10 (97% 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
Community Plan	$7 - $9	68%
Point Comfort Underwriters	$9	87%
UnitedHealthcare	$9 - $10	87%
Amerigroup Mcr Replacement	$10	97%
Ascension Complete	$10	97%
Blue Cross Blue Shield	$10 - $30	97%
Centurion Of Tn	$10	97%
Covid Uninsured Test Fund	$10	97%
Healthspring Mcr Replacement	$10	97%
Humana	$10	97%
Medicare (plans)	$10	97%
Nhc Advantage	$10	97%
Aetna	$11 - $175	107%
Ambetter / Centene	$13	126%
Cigna	$14 - $40	136%
Oscar Health	$14	136%
Smart Health	$14	136%

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 $90.
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 Dekalb Community 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.