CMS Price Transparency Data
Culture, blood
Facility: Watsonville Community Hospital
Billing Code: 87040 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 87040
- Insurance Median: $653
- Cash Discount Price: $709
- vs. Medicare Baseline: 63.28x Medicare
The contracted insurance negotiated median rate for a Culture, blood at Watsonville Community Hospital is $653. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $709. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 63.28x the Medicare baseline. Located in 75 Nielson Street, Watsonville, CA.
Cash / Self-Pay
$709
Average discount available for prompt cash payment at this facility.
Insurance Median
$653
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: $709 (6870%)
Insurance Median: $653 (6328%)
Cash: $709 (6870% of Medicare)
Ins. Median: $653 (6328% 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 6328% of the Medicare baseline (a markup of 6228%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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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 Shield PPO | $10 - $33 | 97% |
| Secure Horizons | $10 | 97% |
| Health Net of California | $10 - $741 | 97% |
| Kemper Group Workers Comp | $10 | 97% |
| Nx Health Network | $10 | 97% |
| Republic Idemnity W/Comp | $10 | 97% |
| Alignment Health Plan | $10 | 97% |
| Pinnacle Healthcare Uc | $10 | 97% |
| Miscellaneous Work Comp | $10 | 97% |
| UnitedHealthcare | $10 - $709 | 97% |
| Travelers Insurance | $10 - $1,182 | 97% |
| Liberty Mutual Work Comp | $10 | 97% |
| Tricare | $10 | 97% |
| Ace-Usa | $10 | 97% |
| Beta Healthcare Group | $10 | 97% |
| Hartford Workers' Comp | $10 | 97% |
| Workers Comp | $10 | 97% |
| U.S. Dept. of Labor | $10 | 97% |
| Gallagher Bassett Svcs | $10 | 97% |
| Western Growers Work Comp | $10 | 97% |
| Secure Horizons Dign HMO | $10 - $236 | 97% |
| Fleming & Associates | $10 | 97% |
| Keenan & Assoc Work Comp | $10 | 97% |
| Crawford & Co | $10 | 97% |
| Fireman's Fund Work Comp | $10 | 97% |
| Medicare (plans) | $10 | 97% |
| Veterans Administration | $10 | 97% |
| Medi-Cal/Eds | $13 | 126% |
| Healthy Families | $13 - $33 | 126% |
| Well Path | $13 - $1,182 | 126% |
| Ccs/Monterey County | $13 | 126% |
| California Childrens Srvs | $13 | 126% |
| Medicaid / KanCare | $13 | 126% |
| Medi-Cal E.R. | $13 | 126% |
| Alliance/Sccho | $14 | 136% |
| United Agriculture | $33 | 320% |
| Bs Employee | $33 | 320% |
| Ufcw/Valley Clerks | $33 | 320% |
| Western Growers Trust/Bc | $69 - $1,053 | 669% |
| State Compensation Fund | $69 - $1,053 | 669% |
| Calif Ironworkers Field | $69 - $1,053 | 669% |
| Claims Management Wc | $69 - $1,053 | 669% |
| Robert Kennedy/Ccn | $69 - $1,053 | 669% |
| Operating Engineers | $69 - $1,053 | 669% |
| Carpenters H&W Trust | $69 - $1,053 | 669% |
| Blue Cross Blue Shield | $69 - $1,053 | 669% |
| Monterey Bay Pub Emp Trst | $69 - $1,053 | 669% |
| Laborers Health & Welfare | $69 - $1,053 | 669% |
| Sheet Metal Workers | $69 - $1,053 | 669% |
| City of Wats/Pinnacle Clm | $69 - $1,053 | 669% |
| Teamsters Benefit Trust | $69 - $1,053 | 669% |
| Delta Health Systems | $69 - $1,053 | 669% |
| Pinnacle Claims Tpa/Bc | $69 - $1,053 | 669% |
| Health Net Pmg HMO | $149 - $741 | 1444% |
| Great-West/Phcs | $149 - $827 | 1444% |
| Cigna | $149 - $827 | 1444% |
| Pacificare HMO | $149 - $709 | 1444% |
| Blue Shield HMO | $149 - $236 | 1444% |
| Aetna | $149 - $969 | 1444% |
| Victim Compensation Plan | $213 - $1,182 | 2064% |
| Medicruz | $213 | 2064% |
| Western Health Advantage | $591 | 5727% |
| Self Pay | $709 | 6870% |
| Health Net Smartcare Netw | $709 | 6870% |
| Pacificare PPO | $709 | 6870% |
| Health Net Canopycare HMO | $741 | 7180% |
| Health Net Blue and Gold | $741 | 7180% |
| Adventist Risk Management | $827 - $945 | 8014% |
| Transwestern | $827 - $945 | 8014% |
| Geha (Ccn) | $827 - $945 | 8014% |
| First Health | $827 - $945 | 8014% |
| Multiplan Inc PPO | $922 | 8934% |
| Private Healthcare System | $922 | 8934% |
| Salinas Valley Mem Hops | $1,004 | 9729% |
| Coastal Healthcare Admin | $1,004 - $1,064 | 9729% |
| United Administrative | $1,182 | 11453% |
| Miscellaneous Auto | $1,182 | 11453% |
| Prucare Pmg POS | $1,182 | 11453% |
| Aarp | $1,182 | 11453% |
| North Calif Bakery Driver | $1,182 | 11453% |
| Aaa | $1,182 | 11453% |
| Humana | $1,182 | 11453% |
| Miscellaneous Insurance | $1,182 | 11453% |
| Allstate | $1,182 | 11453% |
| Zenith National Ins | $1,182 | 11453% |
| Wholesale Beer Distributo | $1,182 | 11453% |
| Bankers Life & Casualty | $1,182 | 11453% |
| Physicians Mutual | $1,182 | 11453% |
| State Farm Ins | $1,182 | 11453% |
| Sutter Health Plus | $1,182 | 11453% |
| Apwu Health Plan | $1,182 | 11453% |
| Prucare Pmg HMO | $1,182 | 11453% |
| Farmers Insurance | $1,182 | 11453% |