CMS Price Transparency Data

Culture, blood

Facility: Seneca District Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $146
Cash Discount Price: $123
vs. Medicare Baseline: 14.15x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Seneca District Hospital is $146. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $123. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 14.15x the Medicare baseline. Located in 130 Brentwood Drive, Chester, CA.

Cash / Self-Pay

$123

Average discount available for prompt cash payment at this facility.

Insurance Median

$146

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: $123 (1192%)

Insurance Median: $146 (1415%)

Cash: $123 (1192% of Medicare)

Ins. Median: $146 (1415% 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 1415% of the Medicare baseline (a markup of 1315%). 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
Amthem Bc Mcal	$12	116%
Medi-Cal	$12	116%
Partnership Hp-All Plans	$12	116%
Ambetter / Centene	$14	136%
UnitedHealthcare	$58 - $150	562%
Tricare	$107	1037%
Imperial Hp Ma-All Plans	$121	1172%
Blue Cross Blue Shield	$126 - $138	1221%
Blue Shield Ipf/Ca Exchange	$137	1328%
Beech Street Corp- All Plans	$146	1415%
Cigna	$146	1415%
Integrated Hp-All Plans	$146	1415%
Interplan Corp- All Plans	$146	1415%
Medincrease- All Plans	$146	1415%
Multiplan- All Plans	$146	1415%
Pacificare - All Plans	$146	1415%
Provider Ntwrk Of America-All Plans	$146	1415%
Alliance- All Plans	$149	1444%
Community Care Network - All Plans	$149	1444%
Coventry- All Plans	$150	1453%
Northern Nevada Health Network- All Plans	$150	1453%
Superior California Ppo - All Plans	$150	1453%
Blue Shield Of Ca- All Other Plans	$152	1473%
Healthnet - All Other Plans	$152	1473%
Three Rivers- All Plans	$152	1473%

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 $123.
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 Seneca District 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.