CMS Price Transparency Data

Culture, blood

Facility: City of Hope National Medical Center

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $168
Cash Discount Price: $240
vs. Medicare Baseline: 16.28x Medicare

The contracted insurance negotiated median rate for a Culture, blood at City of Hope National Medical Center is $168. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $240. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 16.28x the Medicare baseline. Located in 1500 Duarte Rd, Duarte, CA.

Cash / Self-Pay

$240

Average discount available for prompt cash payment at this facility.

Insurance Median

$168

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: $240 (2326%)

Insurance Median: $168 (1628%)

Cash: $240 (2326% of Medicare)

Ins. Median: $168 (1628% 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 1628% of the Medicare baseline (a markup of 1528%). 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	$7 - $233	68%
Cal Optima	$10 - $13	97%
Heritage Provider Network	$11 - $168	107%
Facey	$13	126%
Inland Empire	$13 - $192	126%
Prime Healthcare Keenan	$18 - $231	174%
UnitedHealthcare	$31 - $135	300%
Blue Cross Blue Shield	$103 - $168	998%
Blue Shield	$142 - $310	1376%
Blue Shield Covca	$146	1415%
Blue Shield Promise	$168	1628%
Cencal	$192	1860%
La Care Health	$192	1860%
Kaiser	$216	2093%
Aetna	$240	2326%
Gold Coast	$240	2326%
Molina	$240 - $313	2326%
Cigna	$258	2500%
Healthcare Partners	$279	2703%
St. Joseph Heritage	$289	2800%
Primecare Medical Network	$313	3033%
First Health	$370	3585%
Phcs Multiplan	$433	4196%

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 $240.
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 City of Hope National Medical 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.