CMS Price Transparency Data

Culture, blood

Facility: Medical Center Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $22
Cash Discount Price: $175
vs. Medicare Baseline: 2.13x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Medical Center Hospital is $22. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $175. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 2.13x the Medicare baseline. Located in 500 W 4Th Street, Odessa, TX.

Cash / Self-Pay

$175

Average discount available for prompt cash payment at this facility.

Insurance Median

$22

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: $175 (1696%)

Insurance Median: $22 (213%)

Cash: $175 (1696% of Medicare)

Ins. Median: $22 (213% 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 213% of the Medicare baseline (a markup of 113%). 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
Geha	$5	48%
UnitedHealthcare	$5 - $14	48%
Corvel Wc	$8	78%
Ambetter / Centene	$9 - $11	87%
Amerigroup	$9	87%
Blue Cross Blue Shield	$9 - $117	87%
Community Health Choice	$9	87%
First Care Health Plan	$9	87%
Medicaid / KanCare	$9	87%
Superior Chips	$9	87%
Superior Health Plan	$9	87%
Aetna	$10 - $180	97%
Care Improvement Plus	$10	97%
Humana	$10	97%
Novitas Solutions	$10	97%
Triwest Va Ccn	$10	97%
Wellcare By Allwell	$11	107%
Group Resources	$12	116%
Workers Comp	$21	203%
Health Select	$28 - $117	271%
90 Degree Benefits	$34 - $131	329%
Cigna	$35	339%
Caprock	$45 - $53	436%
Healthsmart Preferred Care	$49 - $164	475%
State Comptroller	$136	1318%
Texas Mutual Wc	$180	1744%
Firstcare	$191	1851%

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 $175.
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 Medical Center 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.