CMS Price Transparency Data

Culture, blood

Facility: Scripps Memorial Hospital La Jolla

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $118
Cash Discount Price: $185
vs. Medicare Baseline: 11.43x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Scripps Memorial Hospital La Jolla is $118. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $185. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 11.43x the Medicare baseline. Located in 9888 Genesee Avenue, La Jolla, CA.

Cash / Self-Pay

$185

Average discount available for prompt cash payment at this facility.

Insurance Median

$118

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: $185 (1793%)

Insurance Median: $118 (1143%)

Cash: $185 (1793% of Medicare)

Ins. Median: $118 (1143% 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 1143% of the Medicare baseline (a markup of 1043%). 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
Aetna	$10 - $372	97%
Astiva Mcr Adv [464]	$10	97%
Bc Mcr Adv [830]	$10	97%
Blue Cross Blue Shield	$10 - $195	97%
Bs Mcr Adv [829]	$10	97%
Central Health Mcr Adv [441]	$10	97%
Cigna	$10 - $255	97%
Clever Care Mcr Adv [465]	$10	97%
D-Snp Mcr Adv [889]	$10	97%
Dsnp/Csnp - Generic [458]	$10	97%
Family Health Centers Pace Mcr Adv Hmo [556]	$10	97%
Family Health Centers Pace Medi-Cal [555]	$10	97%
Gary And Mary West Pace Medi-Cal Hmo [557]	$10	97%
Gpmg/Altura - Mcr Adv [888]	$10	97%
Hn Mcr Adv [832]	$10	97%
Humana	$10	97%
Integrated Health Partners - Mcr Adv [895]	$10	97%
Kaiser Northern Ca Region Mcr Adv [386]	$10	97%
La Care Mcr Adv Hmo [612]	$10	97%
Medicare (plans)	$10	97%
Mpmg Mcr Adv [836]	$10	97%
Mpmg [800]	$10	97%
Ocn Mcr Adv [890]	$10	97%
San Diego Pace Medi-Cal [553]	$10	97%
Scan Mcr Adv [835]	$10	97%
Scan [500]	$10	97%
Scan [818]	$10	97%
Sharp Comm Med Grp Mcr Adv [840]	$10	97%
Sharp Health Plan Mcr Adv [531]	$10	97%
Sharp Health Plan Mcr Adv [897]	$10	97%
Sharp Rees Stealy Med Grp Mcr Adv [841]	$10	97%
St Paul'S Pace Medi-Cal [551]	$10	97%
Ucsd Mcr Adv [873]	$10	97%
Uh Mcr Adv [831]	$10	97%
Uh Palomar Health Mcr Adv [885]	$10	97%
UnitedHealthcare	$10 - $258	97%
Alignment Health Plan [443]	$11	107%
Health Net [340]	$16 - $248	155%
Prime Healthcare [614]	$18	174%
Prospect Med Group [893]	$18	174%
Radys Cpmg [803]	$59	572%
Mc Alignment [917]	$111 - $118	1076%
Mc Blue Shield Promise Health Plan [914]	$111 - $118	1076%
Mc Blue Shield [902]	$111 - $118	1076%
Mc Health Net [904]	$111 - $118	1076%
Mc Scan [905]	$111 - $118	1076%
Mc United [906]	$111 - $118	1076%
Bc [814]	$163	1579%
Imperial County Phys Med Group [855]	$163 - $252	1579%
Integrated Health Partners [894]	$163	1579%
Perlman Med Group [899]	$163	1579%
Sharp Comm Med Grp [812]	$163 - $335	1579%
Sharp Rees Stealy Med Grp [811]	$163 - $335	1579%
Ucsd [807]	$163 - $335	1579%
Centivo [581]	$170	1647%
Blue Shield [230]	$243 - $264	2355%
Hn [815]	$248	2403%
Bs [816]	$252 - $262	2442%
Uh [819]	$258	2500%
Kaiser Northern Ca Region Hmo/Ppo [384]	$281	2723%
Kaiser [380]	$281	2723%
Kaiser [383]	$281	2723%
Rady Children'S Hospital [825]	$303	2936%
Palomar Health [892]	$335	3246%
Veba Med Grp [813]	$335	3246%
Multi Plan Network [470]	$524	5078%
First Health Network [330]	$554	5368%
Pnoa [615]	$554	5368%
Choice Care Network [270]	$591	5727%
Healthsmart [350]	$591	5727%

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 $185.
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 Scripps Memorial Hospital La Jolla 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.