CMS Price Transparency Data

Culture, blood

Facility: Adventist Health Tulare

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $87
Cash Discount Price: $94
vs. Medicare Baseline: 8.43x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Adventist Health Tulare is $87. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $94. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 8.43x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$94

Average discount available for prompt cash payment at this facility.

Insurance Median

$87

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: $94 (911%)

Insurance Median: $87 (843%)

Cash: $94 (911% of Medicare)

Ins. Median: $87 (843% 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 843% of the Medicare baseline (a markup of 743%). 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
Blue Cross Blue Shield	$3 - $105	29%
Blue Shield Mcare	$10	97%
Dignity Mcr Op Only - All Other Plans	$10	97%
Fhcn Pace Mcr Adv - All Plans	$10	97%
Medicare (plans)	$10	97%
Prime Health - All Plans	$10	97%
Tricare	$10	97%
UnitedHealthcare	$10 - $524	97%
Medi-Cal	$12	116%
Cal Forensic Med Grp - All Plans	$13	126%
Dignity Mcal Op Only	$13	126%
Independence Op Only - All Plans	$13	126%
Prison Hlthcre - All Plans	$13	126%
Bright Health - All Plans	$15	145%
Ccipa Medi-Cal - All Plans	$15	145%
Healthnet Medi-Cal	$16	155%
Ah Employee Health Plan - All Plans	$19	184%
Incentive Hlth - All Plans	$19	184%
Healthnet Hmo/Ppo - All Other Plans	$28	271%
Blue Shield Epn	$85 - $229	824%
Aetna	$89	862%
Blue Shield-All Other Plans	$117 - $316	1134%
Western Growers - All Plans	$123 - $333	1192%
Cigna	$124 - $335	1202%
Network By Design-All Plans	$174 - $471	1686%
Hs Interplan-All Plans	$180 - $485	1744%
Multiplan - All Plans	$228 - $615	2209%

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 $94.
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 Tulare 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.