CMS Price Transparency Data

Culture, blood

Facility: Loma Linda University Children's Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $49
Cash Discount Price: $113
vs. Medicare Baseline: 4.75x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Loma Linda University Children's Hospital is $49. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $113. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 4.75x the Medicare baseline. Located in 11234 Anderson Street Suite A, Loma Linda, CA.

Cash / Self-Pay

$113

Average discount available for prompt cash payment at this facility.

Insurance Median

$49

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: $113 (1095%)

Insurance Median: $49 (475%)

Cash: $113 (1095% of Medicare)

Ins. Median: $49 (475% 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 475% of the Medicare baseline (a markup of 375%). 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
UnitedHealthcare	$8	78%
Alpha Care Medical Group	$10 - $15	97%
Dignity Health	$10 - $15	97%
Epic Health Plan	$10 - $156	97%
Inland Empire Health Plan (Iehp)	$10 - $15	97%
Kaiser Foundation Hospitals	$10 - $260	97%
Upland Medical Group	$10	97%
Vantage Medical Group	$10 - $15	97%
Molina Healthcare Of Ca	$13 - $14	126%
Heritage Provider Network	$17	165%
Adventist Health	$22 - $78	213%
Lluh Dept Of Risk Management	$26 - $94	252%
Blue Shield Of California	$49 - $74	475%
Global Benefits Group	$66 - $234	640%
Temecula Valley Physicians Medical Group	$66	640%
Trivalley Medical Group	$66	640%
Cigna	$70 - $81	678%
Aetna	$72	698%
Networks By Design	$72 - $254	698%
Multiplan	$88 - $312	853%
Galaxy Health	$94 - $332	911%
Prime Health Services	$94 - $332	911%
Blue Cross Blue Shield	$102	988%

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 $113.
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 Loma Linda University Children's 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.