CMS Price Transparency Data

Culture, blood

Facility: Grossmont Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $211
Cash Discount Price: $317
vs. Medicare Baseline: 20.45x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Grossmont Hospital is $211. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $317. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 20.45x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$317

Average discount available for prompt cash payment at this facility.

Insurance Median

$211

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: $317 (3072%)

Insurance Median: $211 (2045%)

Cash: $317 (3072% of Medicare)

Ins. Median: $211 (2045% 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 2045% of the Medicare baseline (a markup of 1945%). 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
Health Net	$27 - $143	262%
Blue Shield	$125 - $295	1211%
Humana	$125	1211%
Medicare (plans)	$125 - $295	1211%
Cigna	$127 - $129	1231%
Allianz Global Assistance	$129 - $235	1250%
Blue Cross Blue Shield	$129 - $295	1250%
Indian Health Council	$143	1386%
Interplan	$143	1386%
California Health And Wellness	$207	2006%
UnitedHealthcare	$211 - $238	2045%
Molina	$213 - $380	2064%
Kaiser	$261	2529%
Community Health Group	$264 - $307	2558%
Epic Americas	$283	2742%
San Diego Pace	$295	2859%
Aetna	$338	3275%
Managed Health Network	$380	3682%

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 $317.
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 Grossmont 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.