CMS Price Transparency Data

Culture, blood

Facility: Shriners Hospitals for Children - Philadelphia

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $14
Cash Discount Price: $91
vs. Medicare Baseline: 1.36x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Shriners Hospitals for Children - Philadelphia is $14. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $91. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 1.36x the Medicare baseline. Located in 3551 N Broad Street, Philadelphia, PA.

Cash / Self-Pay

$91

Average discount available for prompt cash payment at this facility.

Insurance Median

$14

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: $91 (882%)

Insurance Median: $14 (136%)

Cash: $91 (882% of Medicare)

Ins. Median: $14 (136% 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.

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
Soonercare	$9	87%
Aetna	$10 - $14	97%
Ambetter / Centene	$10 - $19	97%
Cigna	$11	107%
Providence Health Plan	$11	107%
Amerihealth Caritas Nc	$12	116%
Amerihealth Caritas Sc	$12	116%
Humana	$13	126%
Amerihealth Mercy Health Plans	$14	136%
Blue Cross Blue Shield	$14 - $22	136%
Gateway Health Plan	$14	136%
Geisinger Health Plan	$14	136%
Health Partners Of Philadelphia	$14	136%
Keystone Mercy Health Plans	$14	136%
Sana Benefits	$14	136%
Upmc Health Plan	$14	136%
Amerihealth Caritas Of Nc	$19	184%
Wellcare Of North Carolina	$19	184%

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 $91.
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 Shriners Hospitals for Children - Philadelphia 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.