CMS Price Transparency Data
Culture, blood
Facility: Trinity Health Muskegon Hospital
Billing Code: 87040 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 87040
- Insurance Median: $75
- Cash Discount Price: $65
- vs. Medicare Baseline: 7.27x Medicare
The contracted insurance negotiated median rate for a Culture, blood at Trinity Health Muskegon Hospital is $75. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $65. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 7.27x the Medicare baseline. Located in 1500 E Sherman Blvd, Muskegon, MI.
Cash / Self-Pay
$65
Average discount available for prompt cash payment at this facility.
Insurance Median
$75
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: $65 (630%)
Insurance Median: $75 (727%)
Cash: $65 (630% of Medicare)
Ins. Median: $75 (727% 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 727% of the Medicare baseline (a markup of 627%). 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.
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 | $6 - $13 | 58% |
| Medicaid / KanCare | $6 | 58% |
| Access Health | $7 | 68% |
| Aetna | $10 - $42 | 97% |
| Align Senior Care | $10 | 97% |
| Blue Care Network Advantage | $10 | 97% |
| Correctional Recovery | $10 | 97% |
| Heartland Hospice | $10 | 97% |
| Hospice Harbor Hospice | $10 | 97% |
| Medicare (plans) | $10 | 97% |
| Oscar | $10 | 97% |
| UnitedHealthcare | $11 - $88 | 107% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $12 | 116% |
| U Of M Health Plan | $12 - $79 | 116% |
| Bcn Domestic | $13 | 126% |
| Blue Benefit Administrators Of Massachusetts | $13 | 126% |
| Blue Care Network | $13 | 126% |
| Blue Distinction Transplant | $13 | 126% |
| Blue Shield - Ca | $13 | 126% |
| Blue Shield - Id (Regence) | $13 | 126% |
| Blue Shield - Ny Highmark Northeastern | $13 | 126% |
| Blue Shield - Ny Highmark Western | $13 | 126% |
| Blue Shield - Pa (Highmark) | $13 | 126% |
| Blue Shield - Wa (Regence) | $13 | 126% |
| Health Choices | $13 - $79 | 126% |
| Kaiser Domestic | $13 | 126% |
| Molina Marketplace | $13 | 126% |
| Geha | $15 - $88 | 145% |
| Meritain | $15 | 145% |
| Vitalcore | $16 | 155% |
| Wellpath | $16 | 155% |
| Priority Health | $37 - $42 | 359% |
| Acs Benefit Services | $52 | 504% |
| Allied Benefit Systems | $52 | 504% |
| Claimchoice Adminstrators | $52 | 504% |
| Consociate | $52 | 504% |
| Cypress Benefit Administrators | $52 | 504% |
| Forest County Potawatomi | $52 | 504% |
| Health Smart | $52 | 504% |
| Healthgram | $52 | 504% |
| Healthscope | $52 | 504% |
| Preferred One | $52 | 504% |
| Secureone Preferred United Plans | $52 | 504% |
| Sisco Benefits | $52 | 504% |
| The Health Plan | $52 | 504% |
| Trustmark Small Business Benefits | $52 | 504% |
| Unified Group Services | $52 | 504% |
| Webtpa | $52 | 504% |
| Asr Health Benefits | $53 | 514% |
| Hap | $53 - $79 | 514% |
| Wc Accident Fund | $53 | 514% |
| Wc Advantage | $53 | 514% |
| Wc Aig | $53 | 514% |
| Wc Allied | $53 | 514% |
| Wc Amerisure | $53 | 514% |
| Wc Amtrust | $53 | 514% |
| Wc Asu Risk Mgt | $53 | 514% |
| Wc Berkley Admin | $53 | 514% |
| Wc Broadspire | $53 | 514% |
| Wc Bunch & Associates | $53 | 514% |
| Wc Ccmsi | $53 | 514% |
| Wc Emc Insurance Company | $53 | 514% |
| Wc Esis | $53 | 514% |
| Wc Fcci | $53 | 514% |
| Wc Federated | $53 | 514% |
| Wc Gallagher Bassett | $53 | 514% |
| Wc Genex Care For Ohio | $53 | 514% |
| Wc Guard Insurance Company | $53 | 514% |
| Wc Hartford | $53 | 514% |
| Wc Liberty Mutual | $53 | 514% |
| Wc Meijers | $53 | 514% |
| Wc Michigan | $53 | 514% |
| Wc Mitchell Frankenmuth | $53 | 514% |
| Wc Pma | $53 | 514% |
| Wc Sedgwick | $53 | 514% |
| Wc Sentry | $53 | 514% |
| Wc Travelers | $53 | 514% |
| Wc Tristar | $53 | 514% |
| Wc Walmart | $53 | 514% |
| Wc Zurich | $53 | 514% |
| Hospice Of Michigan | $55 | 533% |
| Nomi Health | $56 | 543% |
| Varipro | $58 | 562% |
| Caresource | $63 | 610% |
| Cigna | $63 | 610% |
| 1199 National Benefit Fund | $75 | 727% |
| Allied National Global Care | $75 | 727% |
| Asrm - Reliance Standard Life Insurance | $75 | 727% |
| Christian Care Ministry | $75 | 727% |
| Dean Health | $75 | 727% |
| Fallon Health | $75 | 727% |
| Family Life Insurance Company | $75 | 727% |
| Ghc Scw | $75 | 727% |
| Group Pension Administrators | $75 | 727% |
| International Benefit Administrators | $75 | 727% |
| Lifetime Benefit Solutions | $75 | 727% |
| Manhattan Life | $75 | 727% |
| Medi Share | $75 | 727% |
| Multiplan | $75 | 727% |
| Mvp | $75 | 727% |
| Pai | $75 | 727% |
| Pan-American Life | $75 | 727% |
| Paramount Hmo | $75 | 727% |
| Phcs | $75 | 727% |
| Trinity Health Share | $75 | 727% |
| Acclaim | $79 | 766% |
| Administrative Concepts | $79 | 766% |
| Allegeant | $79 | 766% |
| Ameriben | $79 | 766% |
| American Family | $79 | 766% |
| American Healthcare Alliance | $79 | 766% |
| American Republic | $79 | 766% |
| Amerihealth | $79 | 766% |
| Aultcare | $79 | 766% |
| Automated Benefit Services | $79 | 766% |
| Auxiant | $79 | 766% |
| Benefit Administrative Systems,Llc | $79 | 766% |
| Boon Chapman | $79 | 766% |
| Cam Administrative Services | $79 | 766% |
| Christian Brother Services | $79 | 766% |
| Christian Brothers Holy Cross | $79 | 766% |
| Comprehensive Benefits | $79 | 766% |
| Continental Life Insurance | $79 | 766% |
| Custom Benefit Administrators | $79 | 766% |
| Employee Benefit Concepts | $79 | 766% |
| Employee Benefit Management | $79 | 766% |
| Enterprise Group Planning | $79 | 766% |
| Freedom Life Insurance Company | $79 | 766% |
| Group Administrators | $79 | 766% |
| Group Marketing Services | $79 | 766% |
| Guardian | $79 | 766% |
| Health America | $79 | 766% |
| Healthez | $79 | 766% |
| Humana | $79 | 766% |
| Insight | $79 | 766% |
| Intercare | $79 | 766% |
| Jfp Benefit Management | $79 | 766% |
| Jp Farley Corporation | $79 | 766% |
| Key Benefit Administrator | $79 | 766% |
| Liberty Union Life Assurance Co | $79 | 766% |
| Lucent Health | $79 | 766% |
| Luminare Health | $79 | 766% |
| Luminare Health (Detroit) | $79 | 766% |
| Medben | $79 | 766% |
| Medcost | $79 | 766% |
| Medical Mutual | $79 | 766% |
| Mutual Health Services | $79 | 766% |
| Mutual Of Omaha | $79 | 766% |
| Ncas | $79 | 766% |
| Nippon Life Ins | $79 | 766% |
| Nova | $79 | 766% |
| Painters Union Insurance Fund | $79 | 766% |
| Physicians Mutual | $79 | 766% |
| Plumbers Local 98 Insurance Fund | $79 | 766% |
| Prairie States | $79 | 766% |
| Primary Physician Care | $79 | 766% |
| Professional Benefit Administrators | $79 | 766% |
| The Loomis Company | $79 | 766% |
| Unicare | $79 | 766% |
| Us Health And Life | $79 | 766% |
| Valenz | $79 | 766% |
| Western & Southern Financial Group | $79 | 766% |
| Wps | $79 | 766% |
| First Health | $82 | 795% |
| Barinet | $100 | 969% |
| Cmh Allegan County | $100 | 969% |
| Cmh Barry County | $100 | 969% |
| Cmh Berrien County | $100 | 969% |
| Cmh Cass County | $100 | 969% |
| Cmh Kalamazoo | $100 | 969% |
| Cmh Kent County | $100 | 969% |
| Cmh Misc | $100 | 969% |
| Cmh Muskegon County | $100 | 969% |
| Cmh North Country | $100 | 969% |
| Cmh Northern Lakes County | $100 | 969% |
| Cmh Ottawa County | $100 | 969% |
| Cmh Van Buren County | $100 | 969% |
| Cmh West Mi County | $100 | 969% |