CMS Price Transparency Data

Culture, blood

Facility: Avita Ontario

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $55
Cash Discount Price: $120
vs. Medicare Baseline: 5.33x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Avita Ontario is $55. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $120. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 5.33x the Medicare baseline. Located in 715 Richland Mall, Ontario, OH.

Cash / Self-Pay

$120

Average discount available for prompt cash payment at this facility.

Insurance Median

$55

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: $120 (1163%)

Insurance Median: $55 (533%)

Cash: $120 (1163% of Medicare)

Ins. Median: $55 (533% 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 533% of the Medicare baseline (a markup of 433%). 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	$28	271%
Medicaid / KanCare	$28	271%
Molina	$28 - $5,629	271%
Ohiorise	$28	271%
United_Healthcare	$28 - $120	271%
Amerihealth	$29	281%
Blue Cross Blue Shield	$29 - $3,518	281%
Buckeye	$30 - $3,518	291%
Humana	$30 - $3,518	291%
Aetna	$55 - $3,588	533%
Medicare (plans)	$55 - $3,518	533%
Mount_Carmel	$55 - $3,518	533%
Medical_Mutual	$56 - $3,588	543%
Cigna	$110	1066%

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 $120.
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 Avita Ontario 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.