Culture, blood
Facility: Nmc Health
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $74
- Cash Discount Price: $80
- vs. Medicare Baseline: 7.17x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 717% of the Medicare baseline (a markup of 617%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $33 | 320% |
| Blue Cross Blue Shield | $38 | 368% |
| Wppa | $63 | 610% |
| Occunet | $68 | 659% |
| Samaritan Ministries International | $74 | 717% |
| Medincrease Health Plan | $74 | 717% |
| Prime Health Services | $86 | 833% |
| UnitedHealthcare | $103 | 998% |
| Cigna | $108 | 1047% |
Consumer Guidance & Cost Commentary
For CPT code 87040, Culture, blood, at Nmc Health in Newton, KS, the cash median price is $80.00, which is lower than the facility's negotiated rates for most payers. While the facility's negotiated average is $74.00, individual commercial rates range from $33 for Aetna to $108 for Cigna, with the gross charge listed at $114.00. It is important to note that cash-pay can sometimes be the most cost-effective option for patients with high-deductible plans, as the $80.00 cash price is significantly lower than the negotiated amounts many insurers charge. Additionally, patients should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill before insurance processing begins.
When evaluating this charge, it is crucial to compare rates against the Medicare benchmark rather than the hospital's gross list price. The Medicare amount for this service is $10.32, and the facility's rate is 7.2 times higher than this federal baseline, which aligns with typical commercial pricing structures that often range from 200% to 300% of Medicare. While the facility is a voluntary non-profit acute care hospital with a 5-star rating, patients should verify their specific plan's deductible status before scheduling, as paying the negotiated rate without meeting the deductible may result in higher out-of-pocket costs. Finally, if a balance bill arises from out-of-network ancillary services, patients are protected under the No Surprises Act and should request an itemized audit to identify any unbundled codes or errors before making