CMS Price Transparency Data

Culture, blood

Facility: Tri Valley Health System

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $217
Cash Discount Price: $282
vs. Medicare Baseline: 21.03x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Tri Valley Health System is $217. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $282. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 21.03x the Medicare baseline. Located in 1305 West Highway 6/34, Cambridge, NE.

Cash / Self-Pay

$282

Average discount available for prompt cash payment at this facility.

Insurance Median

$217

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: $282 (2733%)

Insurance Median: $217 (2103%)

Cash: $282 (2733% of Medicare)

Ins. Median: $217 (2103% 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 2103% of the Medicare baseline (a markup of 2003%). 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	$138 - $297	1337%
Humana	$138	1337%
Medica Mcr Adv	$138	1337%
Medica Prime Sol	$138	1337%
Tricare	$138	1337%
Wellcare Mcr Adv - All Plans	$138	1337%
Great Plains Mcr Adv - All Plans	$145	1405%
Healthy Blue Mcaid - All Plans	$150	1453%
Molina Mcaid - All Plans	$150	1453%
Nebraska Total Care-All Plans	$150	1453%
UnitedHealthcare	$150 - $300	1453%
Amerigroup Mcaid - All Plans	$153	1483%
Medica Chi Aco - All Other Plans	$282	2733%
Medica Chi Open Access	$282	2733%
Medica Ifb Aco	$282	2733%
Medica Ifb Open Access	$282	2733%
Midlands Choice-All Plans	$282	2733%
Aetna	$307	2975%
Multiplan-All Plans	$307	2975%

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 $282.
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 Tri Valley Health System 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.