CMS Price Transparency Data

Culture, blood

Facility: PAM Health Rehabilitation Hospital of Sugar Land LLC

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $268
Cash Discount Price: $357
vs. Medicare Baseline: 25.97x Medicare

The contracted insurance negotiated median rate for a Culture, blood at PAM Health Rehabilitation Hospital of Sugar Land LLC is $268. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $357. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 25.97x the Medicare baseline. Located in 7622 Branford Pl, Sugar Land, TX.

Cash / Self-Pay

$357

Average discount available for prompt cash payment at this facility.

Insurance Median

$268

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: $357 (3459%)

Insurance Median: $268 (2597%)

Cash: $357 (3459% of Medicare)

Ins. Median: $268 (2597% 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 2597% of the Medicare baseline (a markup of 2497%). 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
Wellpoint (Amerigroup)	$9	87%
America'S Choice Provider Network	$250	2422%
Quik Trip	$268	2597%
Usa Managed Care Organization	$268	2597%
Velocity Provider Ppo Network	$268	2597%
Multiplan/Phcs	$286	2771%
Prime Health Services	$303	2936%

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 $357.
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 PAM Health Rehabilitation Hospital of Sugar Land LLC 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.