CMS Price Transparency Data

Culture, blood

Facility: Children's Healthcare of Atlanta at Scottish Rite

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $339
Cash Discount Price: $495
vs. Medicare Baseline: 32.85x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Children's Healthcare of Atlanta at Scottish Rite is $339. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $495. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 32.85x the Medicare baseline. Located in 1001 Johnson Ferry Road, Atlanta, GA.

Cash / Self-Pay

$495

Average discount available for prompt cash payment at this facility.

Insurance Median

$339

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: $495 (4797%)

Insurance Median: $339 (3285%)

Cash: $495 (4797% of Medicare)

Ins. Median: $339 (3285% 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 3285% of the Medicare baseline (a markup of 3185%). 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
Caresource [61]	$15	145%
Peachstate [43]	$15	145%
Amerigroup [102]	$17	165%
Cigna	$327	3169%
Blue Cross Blue Shield	$328 - $483	3178%
United [5]	$328	3178%
Ambetter / Centene	$331	3207%
Oscar [228]	$332	3217%
Aetna	$333	3227%
Caresource Marketplace Bronze/Silver/Gold [60]	$336	3256%
Kaiser [6]	$337	3266%
Sidecar Health [236]	$342	3314%
Direct Employer Agreements [72]	$346 - $421	3353%
Coventry [9]	$347	3362%
Northeast Georgia Heatlh System [808]	$371	3595%
Veracity Benefits [809]	$371	3595%
First Health [74]	$372	3605%
Phcs [93]	$421	4079%
Secure Health [340]	$421	4079%
Beech Street [71]	$446	4322%
Multiplan [92]	$485	4700%
Novanet [41]	$495	4797%

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 $495.
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 Children's Healthcare of Atlanta at Scottish Rite 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.