CMS Price Transparency Data

Culture, blood

Facility: Adventist Health Sierra Vista

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $23
Cash Discount Price: $185
vs. Medicare Baseline: 2.23x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Adventist Health Sierra Vista is $23. 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 2.23x the Medicare baseline. Located in 1010 Murray St, San Luis Obispo, CA.

Cash / Self-Pay

$185

Average discount available for prompt cash payment at this facility.

Insurance Median

$23

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: $23 (223%)

Cash: $185 (1793% of Medicare)

Ins. Median: $23 (223% 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 223% of the Medicare baseline (a markup of 123%). 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	97%
Cencal Mcr Adv - All Other Plans	$10	97%
Tricare	$10	97%
UnitedHealthcare	$10 - $709	97%
Cfmg-Ca Forensic Med Grp Op/Profee Only-All Plans	$13	126%
Medi-Cal	$15	145%
Ah Employee Health Plan - All Plans	$19	184%
Coalinga-All Plans	$20	194%
Blue Shield Epo/Ppo-All Other Plans	$22	213%
Nbd-Ntwrks By Design Exclus-All Other Plans	$24	233%
Blue Shield Promise Mcal	$49	475%
Hpn-Heritage Prov Ntwrk-All Plans	$140	1357%
Blue Shield Hmo/Pos	$202	1957%
Blue Shield Epn	$808	7829%
Nbd-Ntwrks By Design Non-Exclus	$1,190	11531%
Cencal Mcal	$2,350	22771%
Ccah-Centrl Ca Allince Mcal-All Plans	$2,679	25959%

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 Adventist Health Sierra Vista 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.