CMS Price Transparency Data

Culture, blood

Facility: Margaretville Memorial Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $77
Cash Discount Price: $176
vs. Medicare Baseline: 7.46x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Margaretville Memorial Hospital is $77. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $176. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 7.46x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

$176

Average discount available for prompt cash payment at this facility.

Insurance Median

$77

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: $176 (1705%)

Insurance Median: $77 (746%)

Cash: $176 (1705% of Medicare)

Ins. Median: $77 (746% 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 746% of the Medicare baseline (a markup of 646%). 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
Oxford	$15	145%
UnitedHealthcare	$15 - $77	145%
Aetna	$28 - $176	271%
Mvp	$44	426%
Blue Cross Blue Shield	$51 - $77	494%
Mvp Hmo/Ppo	$52	504%
Self-Pay	$74	717%
Medicare (plans)	$77 - $116	746%
Mvp Gold (McR)	$77	746%
Hamaspik (McR)	$77	746%
Affinity By Molina McR	$81	785%
Cdphp	$85	824%
Emblem Ghi/Hip Ppo/Cbp	$109	1056%
Mvp Exchange	$114	1105%
Emblem Select Care (Exchange)	$120	1163%
Magnacare Standard	$123	1192%
Oxford Exchange	$123	1192%
Todays Options	$128	1240%
Emblem Ghi/Hip Hmo/Epo/Pos	$141	1366%
Multiplan	$144	1395%
First Health	$158	1531%
Magnacare Preferred	$695	6734%

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 $176.
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 Margaretville Memorial 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.