CMS Price Transparency Data

Culture, blood

Facility: Metropolitan Hospital Center

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $27
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.62x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Metropolitan Hospital Center is $27. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 2.62x the Medicare baseline. Located in 1901 First Avenue, New York, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$27

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%)

Insurance Median: $27 (262%)

Ins. Median: $27 (262% 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 262% of the Medicare baseline (a markup of 162%). 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
Aetna	$6 - $26	58%
Healthfirst	$7 - $60	68%
Elderplan	$10	97%
Fidelis	$10 - $60	97%
Magnacare	$12	116%
Oscar	$15	145%
Oxford	$15	145%
United	$15 - $33	145%
Centerlight	$18	174%
Wellcare	$22	213%
Carelon	$24 - $27	233%
Cigna	$26	252%
Emblem	$26 - $36	252%
Metroplus	$26 - $60	252%
Affinity	$27 - $60	262%
Amidacare	$27	262%
Blue Cross Blue Shield	$27 - $60	262%
Carelon (Amida Care)	$27	262%
Senior Whole Health	$27	262%
United Behavioral Health	$27 - $29	262%
Vnsny	$27 - $31	262%
Multiplan	$29	281%
Local 1199	$31	300%
Villagecare Max	$31	300%

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 $X.
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 Metropolitan Hospital Center 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.