CMS Price Transparency Data

Culture, blood

Facility: Cincinnati Children's Hospital Medical Center

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $262
Cash Discount Price: $142
vs. Medicare Baseline: 25.39x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Cincinnati Children's Hospital Medical Center is $262. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $142. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 25.39x the Medicare baseline. Located in 3333 Burnet Avenue, Cincinnati, OH.

Cash / Self-Pay

$142

Average discount available for prompt cash payment at this facility.

Insurance Median

$262

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: $142 (1376%)

Insurance Median: $262 (2539%)

Cash: $142 (1376% of Medicare)

Ins. Median: $262 (2539% 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 2539% of the Medicare baseline (a markup of 2439%). 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	$13 - $274	126%
Mhs_In	$13	126%
Caresource_In	$14	136%
Caresource_Oh	$25	242%
Humana	$26 - $70	252%
United_Health_Care_Oh	$26	252%
Amerihealth_Caritas_Oh	$27	262%
Molina_Oh	$27	262%
Buckeye_Oh	$29	281%
Aetna	$70 - $265	678%
Passport_Ky	$73	707%
Wellcare_Ky	$73	707%
United_Health_Care_Ky	$74	717%
Caresource_Oh_Insurance	$134	1298%
Cigna	$134 - $265	1298%
Medical_Mutual_Of_Ohio_Insurance	$173 - $265	1676%
Point_Comfort_Insurance	$181	1754%
Margaret_Mary_Health_Insurance	$218	2112%
Parkview_Signature_Care_Insurance	$218	2112%
United_Health_Care_Insurance	$250	2422%
Health_Ohio_Network_Insurance	$254 - $265	2461%
Custom_Design_Benefits_Insurance	$265	2568%
Health_Smart_Preferred_Insurance	$265	2568%
Medical_Benefit_Administrators_Insurance	$265	2568%
Ohio_Health_Choice_Insurance	$265	2568%
Private_Health_Care_Systems_Insurance	$268	2597%
Beechstreet_Insurance	$273	2645%
First_Health_Group_Insurance	$273	2645%
Health_Link_Insurance	$273	2645%
Evolutions_Health_Care_Systems	$279	2703%
Galaxy_Health_Insurance	$279	2703%

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 $142.
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 Cincinnati Children's Hospital Medical Center 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.