CMS Price Transparency Data

Culture, blood

Facility: Riverside Community Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $12
Cash Discount Price: $1,481
vs. Medicare Baseline: 1.16x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Riverside Community Hospital is $12. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,481. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 1.16x the Medicare baseline. Located in 4445 Magnolia Avenue, Riverside, CA.

Cash / Self-Pay

$1,481

Average discount available for prompt cash payment at this facility.

Insurance Median

$12

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: $1,481 (14351%)

Insurance Median: $12 (116%)

Cash: $1,481 (14351% of Medicare)

Ins. Median: $12 (116% 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
Bristol Hospice	$8	78%
Aetna	$10 - $267	97%
Alignment Health Plan	$10	97%
Blue Cross Blue Shield	$10 - $54	97%
Blue Shield	$10 - $113	97%
Brand New Day	$10 - $13	97%
Central Health Plan	$10	97%
Clever Care Of Golden State	$10	97%
Easy Choice Health Plan	$10	97%
Heritage Provider Network	$10 - $14	97%
Humana	$10	97%
Redlands Community Hospital	$10	97%
Riverside Medical Clinic	$10 - $12	97%
Riverside Physician	$10	97%
Scan Health Plan	$10	97%
Triwest Healthcare Alliance	$10	97%
United	$10 - $390	97%
UnitedHealthcare	$10	97%
Care1St Health Plan	$11	107%
Health Net	$11 - $330	107%
Corvel Corporation	$12	116%
Healthsmart	$12 - $1,185	116%
La Care Health	$12	116%
Molina	$12	116%
Next	$12 - $1,185	116%
Inland Empire Health Plan	$17 - $18	165%
Bright Health	$26	252%
Cigna	$29	281%
Medcare Partners	$222	2151%
First Health	$652 - $1,333	6318%
American Health System	$666	6453%
Multiplan	$1,185 - $1,259	11483%

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 $1,481.
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 Riverside Community 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.