Culture, blood
Facility: Charleston Area Medical Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $26
- Cash Discount Price: $219
- vs. Medicare Baseline: 2.52x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 252% of the Medicare baseline (a markup of 152%). 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Triwest VA | $10 | 97% |
| Optimum Choice Inc. | $10 | 97% |
| Aetna | $10 - $215 | 97% |
| Unicare Health Plan of West Virginia Inc. | $10 | 97% |
| Choicecare Network | $10 - $215 | 97% |
| Blue Cross Blue Shield | $10 - $200 | 97% |
| The Health Plan of West Virginia Inc. | $10 - $212 | 97% |
| UnitedHealthcare | $11 - $215 | 107% |
| West Virginia Senior Advantage Inc. | $11 | 107% |
| Integrated Medical Solutions | $20 | 194% |
| Naphcare | $21 | 203% |
| Caresource | $26 | 252% |
| Tricare | $131 | 1269% |
| City of Charleston | $164 | 1589% |
| Cigna | $204 | 1977% |
| Three Rivers Providers Network | $212 | 2054% |
| Multiplan | $215 | 2083% |
| Healthsmart | $215 | 2083% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood) at Charleston Area Medical Center, the cash median rate is $219, which is significantly higher than the Medicare benchmark of $10.32 and represents a markup of 2.5 times the Medicare amount. When comparing commercial payer rates, the facility's negotiated range spans from $10 to $215, with the highest negotiated rate of $215 being nearly 21 times the Medicare rate. It is important to note that while the cash price of $219 is the highest among the available commercial rates, patients with high-deductible plans may find paying the cash price directly more affordable than their insurance negotiated rate if that rate exceeds the cash amount.
The facility is a Voluntary non-profit - Private Acute Care Hospital located at 501 Morris Street in Charleston, WV, with a facility rating of 2. Among the 18 payers listed, rates vary widely, with some plans like Integrated Medical Solutions, Naphcare, Caresource, Tricare, City of Charleston, Cigna, and Healthsmart all having a single plan rate of $20, $21, $26, $131, $164, $204, and $215 respectively. The lowest negotiated rate across all payers is $10, while the highest is $215. Patients should be aware that hospitals often offer prompt-pay discounts for self-pay patients who settle their bill in full upfront, which can reduce the total cost. Additionally, if a summary bill is received, it is critical to request an itemized audit to ensure no unbund