CMS Price Transparency Data

Culture, blood

Facility: Monroe County Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $94
Cash Discount Price: $114
vs. Medicare Baseline: 9.11x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Monroe County Hospital is $94. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $114. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 9.11x the Medicare baseline. Located in 6580 165Th Street, Albia, IA.

Cash / Self-Pay

$114

Average discount available for prompt cash payment at this facility.

Insurance Median

$94

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: $114 (1105%)

Insurance Median: $94 (911%)

Cash: $114 (1105% of Medicare)

Ins. Median: $94 (911% 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 911% of the Medicare baseline (a markup of 811%). 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
Wellmark Hmo	$9	87%
Wellmark Ppo - All Other Plans	$10	97%
Va Ccn - All Plans	$20	194%
Mahp Mcare - All Plans	$80	775%
Tricare	$80	775%
UnitedHealthcare	$80 - $180	775%
Aetna	$81 - $179	785%
Amerigroup Mcare	$81	785%
Humana	$81	785%
Wellmark Mcare	$81	785%
Iowa Total Care Mcaid - All Plans	$95	921%
Molina Mcaid - All Plans	$96	930%
Amerigroup Mcaid - All Other Plans	$98	950%
Centivo - All Plans	$120	1163%
Midlands Choice - All Plans	$133	1289%
Preferred Hlth - All Plans	$142	1376%
Geha - All Plans	$152	1473%
Multiplan - All Plans	$171	1657%
Integrated Hp - All Plans	$184	1783%

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 $114.
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 Monroe County 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.