CMS Price Transparency Data

Culture, blood

Facility: Boston Children's Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $124
Cash Discount Price: $175
vs. Medicare Baseline: 12.02x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Boston Children's Hospital is $124. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $175. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 12.02x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$175

Average discount available for prompt cash payment at this facility.

Insurance Median

$124

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: $175 (1696%)

Insurance Median: $124 (1202%)

Cash: $175 (1696% of Medicare)

Ins. Median: $124 (1202% 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 1202% of the Medicare baseline (a markup of 1102%). 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	$36 - $116	349%
Unicare	$41	397%
Cdphp	$86 - $149	833%
Harvard Pilgrim	$89 - $118	862%
Aetna	$105 - $147	1017%
United	$105 - $146	1017%
Mgb/Allways	$106 - $129	1027%
Tufts Public Plan	$108	1047%
United Ri Nj Ny	$110	1066%
Ambetter / Centene	$111	1076%
Carelon Strategies/Bhs	$114	1105%
UnitedHealthcare	$114 - $149	1105%
Carelon/Beacon	$131	1269%
Fallon	$134 - $135	1298%
Health New England	$141	1366%
Cigna	$149 - $158	1444%
Ets/Lifetrac	$149	1444%
Interlink Transplant	$149	1444%
Community Health Options	$158	1531%
Humana	$158	1531%
Coventry/Hcvm/First Health	$161	1560%
Multiplan/Phcs	$161 - $166	1560%

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 $175.
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 Boston 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.