Culture, blood
Facility: Northeast Regional Medical Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $243
- Cash Discount Price: $269
- vs. Medicare Baseline: 23.55x 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 2355% of the Medicare baseline (a markup of 2255%). 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 - $15 | 87% |
| Node Champva | $9 | 87% |
| Tricare | $9 | 87% |
| UnitedHealthcare | $10 - $511 | 97% |
| Medicare (plans) | $10 | 97% |
| Blue Access | $10 | 97% |
| Blue Prefrerred | $10 | 97% |
| Veterans Eval Services | $10 | 97% |
| Blue Pathway/Pathway X | $10 | 97% |
| Node Hospice Non Par Agree | $10 | 97% |
| Blue Cross Blue Shield | $10 - $208 | 97% |
| Node VA | $10 | 97% |
| Node Devoted Health McR Adv | $11 | 107% |
| Us Department of Labor | $13 | 126% |
| Centurion Correctional | $13 | 126% |
| Home State Exchange | $19 | 184% |
| Naphcare | $20 | 194% |
| Immergrun | $21 | 203% |
| Self Pay | $163 - $375 | 1579% |
| Cigna | $232 - $266 | 2248% |
| Aetna | $253 - $568 | 2452% |
| Access Health Services, LLC | $443 | 4293% |
| Healthlink | $511 - $545 | 4952% |
| Multiplan | $511 - $545 | 4952% |
| Coventry Wc | $545 | 5281% |
Consumer Guidance & Cost Commentary
The cash price for CPT code 87040 (Culture, blood) at Northeast Regional Medical Center in Kirksville, MO is $269. This cash rate is notably lower than the facility's gross charge of $681, which represents a significant markup compared to the federal Medicare benchmark of $10.32. While the facility's cash price is lower than its gross charges, patients should be aware that many in-network insurers negotiate rates that often exceed cash prices; for instance, Aetna and UnitedHealthcare have negotiated ranges starting at $253 and $10, respectively, which are higher than the available cash option.
For patients with high-deductible plans, paying the cash price of $269 upfront may result in immediate savings compared to in-network costs, provided the patient's insurance allows for out-of-network cash payment. The facility offers a self-pay range of $163 to $511, and patients are encouraged to contact the billing department directly to inquire about prompt-pay discounts, which can further reduce the cost. It is important to note that while the No Surprises Act protects against balance billing for emergency services at in-network facilities, patients should still verify their specific plan details and request an itemized bill to ensure no unexpected ancillary charges are applied before finalizing payment.