CMS Price Transparency Data

Culture, blood

Facility: Southwest General Health Center

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $77
Cash Discount Price: $181
vs. Medicare Baseline: 7.46x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Southwest General Health Center is $77. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $181. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 7.46x the Medicare baseline. Located in 18697 Bagley Road, Middleburg Heights, OH.

Cash / Self-Pay

$181

Average discount available for prompt cash payment at this facility.

Insurance Median

$77

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: $181 (1754%)

Insurance Median: $77 (746%)

Cash: $181 (1754% of Medicare)

Ins. Median: $77 (746% 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 746% of the Medicare baseline (a markup of 646%). 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
Medical Mutual	$4 - $5	39%
Medical Mutual-Ohio	$4	39%
Buckeye	$14 - $61	136%
Molina	$14 - $61	136%
Cigna	$24	233%
Amerihealth Caritas	$61	591%
Blue Cross Blue Shield	$61	591%
Caresource	$61	591%
Humana	$61 - $94	591%
UnitedHealthcare	$61 - $130	591%
Healthsmart	$77	746%
Health Design Plus	$89	862%
Clarity Health	$96	930%
Healthspan	$96	930%
Healthsmart Preferred	$108	1047%
Ohio Health Choice Plus	$117	1134%
Aetna	$130	1260%
Summacare	$130	1260%
Coventry	$166	1609%
First Health	$166	1609%
Ohio Health Choice	$186	1802%
Private Healthare Systems	$193	1870%

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 $181.
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 Southwest General Health 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.