CMS Price Transparency Data

Culture, blood

Facility: Froedtert Community Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $53
Cash Discount Price: $67
vs. Medicare Baseline: 5.14x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Froedtert Community Hospital is $53. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $67. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 5.14x the Medicare baseline. Located in 4805 S Moorland Rd, New Berlin, WI.

Cash / Self-Pay

$67

Average discount available for prompt cash payment at this facility.

Insurance Median

$53

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: $67 (649%)

Insurance Median: $53 (514%)

Cash: $67 (649% of Medicare)

Ins. Median: $53 (514% 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 514% of the Medicare baseline (a markup of 414%). 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
Blue Cross Blue Shield	$10 - $21	97%
Care Wisconsin	$10	97%
Community Care	$10	97%
Health Partners	$10 - $80	97%
Humana	$10	97%
Icare	$10	97%
Molina	$10	97%
Network Health Plan	$10 - $12	97%
Security Health Plan Secure Savers	$10	97%
UnitedHealthcare	$10 - $12	97%
Chorus Community Health Plan	$49	475%
Medical College Of Wisconsin	$49	475%
Centivo	$53 - $61	514%
Cigna	$72	698%
Common Ground	$74	717%
Sheboygan Employers Health Network	$74	717%
Wisconsin Physician Services	$74	717%
Health Payment Systems	$75	727%
Trilogy	$80	775%
Americas Choice	$107	1037%
Healtheos	$107	1037%
Multiplan/Private Healthcare Systems	$107	1037%
First Health Network	$108	1047%

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 $67.
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 Froedtert 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.