Culture, blood
Facility: Neosho Memorial Regional Medical Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $76
- Cash Discount Price: $179
- vs. Medicare Baseline: 7.36x 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 736% of the Medicare baseline (a markup of 636%). 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 |
|---|---|---|
| Medicaid / KanCare | $9 | 87% |
| Blue Cross Blue Shield | $42 - $76 | 407% |
| Tricare | $74 | 717% |
| Humana | $76 | 736% |
| Medicare (plans) | $76 | 736% |
| Medadv_Uhc | $76 | 736% |
| Aetna | $76 | 736% |
| Medadv_Allwell | $76 | 736% |
| Va_Ccn | $76 | 736% |
| Ambetter / Centene | $80 | 775% |
| Wppa_Providrscare | $198 | 1919% |
| United | $199 | 1928% |
| Hpk | $227 | 2200% |
| Coventry | $227 | 2200% |
| Cigna | $227 | 2200% |
Consumer Guidance & Cost Commentary
For the blood culture service (CPT 87040) at Neosho Memorial Regional Medical Center in Chanute, Kansas, the facility's cash median rate of $179.00 is notably higher than the state average of $10.32, reflecting the specific regional cost structure for this Critical Access Hospital. While many commercial payers have negotiated rates ranging from $74 to $80, the facility's cash price remains significantly above the Medicare benchmark of $10.32. Patients with high-deductible plans or those without insurance may find the cash rate more affordable than their specific insurance negotiated rates, which can sometimes exceed the cash price due to administrative overheads included in commercial contracts. It is important to note that while the facility is a government-owned Critical Access Hospital, the cash rate does not automatically align with the lowest possible cost, making it essential to verify if self-pay or prompt-pay discounts are available before scheduling.
When using insurance, the negotiated rates for this service vary widely among the 15 participating plans, with some carriers like Medicaid/KanCare offering a rate as low as $9, while others such as Hpk and Coventry set rates at $227. These commercial rates are substantially higher than the Medicare amount and often exceed the facility's cash median, illustrating that in-network coverage does not guarantee the lowest price. Because the facility is in-network for these payers, the No Surprises Act generally protects patients from balance billing for emergency or non-emergency services, preventing unexpected charges beyond the allowed amount. However, patients should be aware that the high variance in negotiated rates means their specific plan's allowed amount could differ significantly from the facility's cash price,