Culture, blood
Facility: Nemaha Valley Community Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $51
- Cash Discount Price: $89
- vs. Medicare Baseline: 4.94x 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 494% of the Medicare baseline (a markup of 394%). 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 |
|---|---|---|
| Va Ccn - All Plans | $10 | 97% |
| Humana | $44 | 426% |
| Aetna | $44 - $84 | 426% |
| Celtic Comm Exch - All Plans | $48 | 465% |
| Partners Direct Health - All Plans | $51 | 494% |
| Multiplan - All Plans | $89 | 862% |
| Health Partners - All Plans | $94 | 911% |
| Midlands Choice - All Plans | $94 | 911% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood) at Nemaha Valley Community Hospital in Seneca, KS, the facility's cash median price of $89.00 is notably lower than the state average of $92.00. While the hospital's gross charge is $99.00, patients with high-deductible plans may find the cash price more advantageous than the negotiated rates, which range from $44.00 to $94.00 depending on the insurance carrier. It is important to note that while some payers like Aetna and Celtic Comm Exch have negotiated rates exceeding the cash price, others such as Va Ccn and Celtic Comm Exch align closely with or fall below the cash median. Patients should verify their specific plan's negotiated amount before scheduling, as commercial rates can vary significantly even within the same facility.
To ensure you are not overcharged, consider requesting a prompt-pay discount if you choose to pay out-of-pocket, as hospitals often offer immediate fee reductions for upfront payment. Additionally, if you receive a bill from an out-of-network provider or for ancillary services, you may be eligible for protections under the No Surprises Act, which prevents balance billing for emergency and non-emergency care at in-network facilities. If you do receive a surprise bill, do not pay immediately; instead, request an itemized audit to identify any unbundled codes or services not rendered, and formally dispute the charges in writing to avoid unexpected debt.