CMS Price Transparency Data

Culture, blood

Facility: Childrens Hospital of the Kings Daughters Inc

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $222
Cash Discount Price: $264
vs. Medicare Baseline: 21.51x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Childrens Hospital of the Kings Daughters Inc is $222. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $264. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 21.51x the Medicare baseline. Located in 601 Children's Lane, Norfolk, VA.

Cash / Self-Pay

$264

Average discount available for prompt cash payment at this facility.

Insurance Median

$222

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: $264 (2558%)

Insurance Median: $222 (2151%)

Cash: $264 (2558% of Medicare)

Ins. Median: $222 (2151% 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 2151% of the Medicare baseline (a markup of 2051%). 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
Johns Hopkins Healthcare	$10	97%
Blue Cross Blue Shield	$12 - $21	116%
UnitedHealthcare	$12 - $241	116%
Aetna	$15 - $241	145%
Humana	$15	145%
Amerihealth Caritas	$19	184%
Carolina Complete Health	$19	184%
Healthy Blue	$19	184%
Wellcare	$19	184%
Cigna	$195	1890%
Virginia Health Network	$205 - $235	1986%
Medcost	$249 - $270	2413%
First Health	$264	2558%
Multiplan	$270	2616%
Phcs	$270 - $279	2616%
Vhn	$270 - $279	2616%

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 $264.
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 Childrens Hospital of the Kings Daughters Inc 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.