CMS Price Transparency Data

Culture, blood

Facility: Adventist Health and Rideout

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $82
Cash Discount Price: $48
vs. Medicare Baseline: 7.95x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Adventist Health and Rideout is $82. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $48. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 7.95x the Medicare baseline. Located in 726 4Th St, Marysville, CA.

Cash / Self-Pay

$48

Average discount available for prompt cash payment at this facility.

Insurance Median

$82

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: $48 (465%)

Insurance Median: $82 (795%)

Cash: $48 (465% of Medicare)

Ins. Median: $82 (795% 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 795% of the Medicare baseline (a markup of 695%). 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
Bc Mcal	$3	29%
Blue Cross Blue Shield	$10 - $314	97%
Kaiser Mcr Adv	$10	97%
Tricare	$10	97%
UnitedHealthcare	$10 - $354	97%
Healthnet Mcal	$11 - $82	107%
Kaiser Mcal	$12	116%
Medi-Cal	$12	116%
Partnership Hp Mcal -All Plans	$12	116%
Ca Health And Wellness- All Plans	$15	145%
Celtic Mcaid-All Plans	$15	145%
Ah Employee Health Plan - All Plans	$19	184%
Healthnet Comm-All Other Plans	$34 - $244	329%
Aetna	$40 - $288	388%
Kaiser-All Other Plans	$44 - $310	426%
Blue Shield Uc Care Members	$46 - $326	446%
Cigna	$49 - $348	475%
First Health-All Plans	$50 - $357	484%
Phcs-All Plans	$50 - $359	484%
Interplan-All Plans	$52 - $367	504%
Blue Shield-All Other Plans	$54 - $388	523%
Multiplan-All Plans	$54 - $388	523%

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 $48.
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 Adventist Health and Rideout 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.