CMS Price Transparency Data

Culture, blood

Facility: Promedica Monroe Regional Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $14
Cash Discount Price: $62
vs. Medicare Baseline: 1.36x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Promedica Monroe Regional Hospital is $14. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $62. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 1.36x the Medicare baseline. Located in 718 N Macomb St, Monroe, MI.

Cash / Self-Pay

$62

Average discount available for prompt cash payment at this facility.

Insurance Median

$14

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: $62 (601%)

Insurance Median: $14 (136%)

Cash: $62 (601% of Medicare)

Ins. Median: $14 (136% 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.

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
Aetna	$6 - $10	58%
Blue Cross Blue Shield	$6 - $54	58%
Meridian	$6	58%
Molina Healthcare Of Michigan	$6	58%
Priority Health	$6 - $53	58%
UnitedHealthcare	$6 - $78	58%
Health Alliance Plan	$10 - $13	97%
Humana	$10	97%
Paramount Healthcare Inc	$10 - $73	97%
Veterans Affairs	$10	97%
Amerihealth	$12	116%
Frontpath	$56	543%
Encore Health Network	$67	649%
Health Ohio Network, Llc	$67	649%
Cofinity	$68	659%
Multiplan	$86	833%

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 $62.
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 Promedica Monroe Regional 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.