CMS Price Transparency Data

Culture, blood

Facility: Charlevoix Area Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $137
Cash Discount Price: $145
vs. Medicare Baseline: 13.28x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Charlevoix Area Hospital is $137. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $145. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 13.28x the Medicare baseline. Located in 14700 Lakeshore Drive, Charlevoix, MI.

Cash / Self-Pay

$145

Average discount available for prompt cash payment at this facility.

Insurance Median

$137

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: $145 (1405%)

Insurance Median: $137 (1328%)

Cash: $145 (1405% of Medicare)

Ins. Median: $137 (1328% 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 1328% of the Medicare baseline (a markup of 1228%). 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
UnitedHealthcare	$5 - $149	48%
Blue Cross Blue Shield	$7 - $158	68%
Mclaren Health Plan	$7 - $159	68%
Meridian	$7	68%
Priority Health	$7 - $171	68%
Cigna	$11 - $171	107%
Provider Network Of America/Hma Group Health	$14 - $145	136%
Hap (Health Alliance Plan)	$15 - $137	145%
Blue Care Network	$80	775%
Medicare (plans)	$80	775%
Michigan Amish Medical Board	$80	775%
Northern Michigan Mennonite Group	$80	775%
Aetna	$82 - $154	795%
Molina	$87	843%
Hospice Of Michigan	$103	998%
Asr Physicians Care Network	$137	1328%
Employee Benefits Logistics	$137	1328%
Enterprise Group Planning Employee Benefit Plan	$137	1328%
First Health/Coventry Health/Community Care Network	$137	1328%
Medical Cost Savings Solution	$137	1328%
Three Rivers Provider Network	$145	1405%
Iba Health And Life Assurance Company	$157	1521%
Cofinity	$159	1541%
Nomi Health	$159	1541%
Preferred Medical Claim Solutions	$162	1570%

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 $145.
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 Charlevoix Area 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.