CMS Price Transparency Data

Culture, blood

Facility: Valley West Community Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $201
Cash Discount Price: $181
vs. Medicare Baseline: 19.48x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Valley West Community Hospital is $201. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $181. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 19.48x the Medicare baseline. Located in 11 East Pleasant Avenue, Sandwich, IL.

Cash / Self-Pay

$181

Average discount available for prompt cash payment at this facility.

Insurance Median

$201

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: $181 (1754%)

Insurance Median: $201 (1948%)

Cash: $181 (1754% of Medicare)

Ins. Median: $201 (1948% 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 1948% of the Medicare baseline (a markup of 1848%). 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	$47 - $864	455%
Global Excel [1712]	$47 - $201	455%
Humana	$47 - $201	455%
Aetna	$62 - $732	601%
Health'S Finest Network [126]	$111 - $898	1076%
The Alliance [1703]	$134 - $574	1298%
Choicecare [177]	$166 - $712	1609%
Healthlink [125]	$184 - $793	1783%
Multiplan/Phcs [142]	$197 - $1,057	1909%
First Health Plan [6034]	$246 - $1,057	2384%
UnitedHealthcare	$246 - $1,057	2384%

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 $181.
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 Valley West Community 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.