CMS Price Transparency Data

Culture, blood

Facility: University of Wi Hospitals & Clinics Authority

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $128
Cash Discount Price: $132
vs. Medicare Baseline: 12.40x Medicare

The contracted insurance negotiated median rate for a Culture, blood at University of Wi Hospitals & Clinics Authority is $128. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $132. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 12.40x the Medicare baseline. Located in 600 Highland Avenue, Madison, WI.

Cash / Self-Pay

$132

Average discount available for prompt cash payment at this facility.

Insurance Median

$128

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: $132 (1279%)

Insurance Median: $128 (1240%)

Cash: $132 (1279% of Medicare)

Ins. Median: $128 (1240% 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 1240% of the Medicare baseline (a markup of 1140%). 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
Aetna	$10 - $176	97%
Blue Cross Blue Shield	$10 - $209	97%
Humana	$10	97%
Medicare (plans)	$10 - $11	97%
UnitedHealthcare	$10 - $138	97%
Alliance_Premier_Network	$105	1017%
Mercycare	$109	1056%
Triology	$112 - $134	1085%
Security_Health_Plan	$119 - $140	1153%
Employer'S_Coalition_On_Health	$121 - $169	1172%
Alliance	$124	1202%
Hfn	$125 - $169	1211%
United_Healthcare	$126 - $187	1221%
Aspirus_Health_Plan	$128	1240%
Beloit_Health_System	$128	1240%
Cigna	$132	1279%
Health_Partners_Insurance	$134	1298%
Health_Payment_Systems	$135	1308%
Dean_Health_Plan	$141	1366%
Medical_Associates	$145	1405%
Wps	$152 - $168	1473%
Employers_Healthcare_Coalition_Of_Wi	$154	1492%
Aspirus_Network_Inc	$169	1638%
Chorus_Community	$176	1705%
Ghc_Eau_Claire_Health_Plan	$176	1705%
Multiplan	$176 - $202	1705%
Sheybogan_Employers_Health_Network	$176	1705%
Coventry	$187	1812%
Dean_Care	$187	1812%
Healthsmart	$194	1880%

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 $132.
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 University of Wi Hospitals & Clinics Authority 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.