Culture, blood
Facility: Susan B Allen Memorial Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $554
- Cash Discount Price: $26
- vs. Medicare Baseline: 53.68x 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 5368% of the Medicare baseline (a markup of 5268%). 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 |
|---|---|---|
| UnitedHealthcare | $350 | 3391% |
| Providrs Care | $757 | 7335% |
Consumer Guidance & Cost Commentary
For the "Culture, blood" procedure (CPT 87040) at Susan B Allen Memorial Hospital in El Dorado, KS, the facility's cash median price is $26.00, which is significantly lower than the negotiated rates of $350.00 and $757.00 charged by UnitedHealthcare and Providrs Care, respectively. While Medicare sets a baseline reimbursement of $10.32 for this service, patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds $26.00. It is important to note that commercial insurance rates often include administrative overhead and contract premiums, making them higher than the direct cash price even though they serve as a ceiling for in-network billing.
Before scheduling, patients should verify whether the facility offers "self-pay" or "prompt-pay" discounts, which can further reduce the $26.00 cash median by bypassing costly claims processing fees. Although the hospital is a voluntary non-profit acute care facility, the data does not provide a specific state or county average for comparison, so patients should rely on the Medicare benchmark of $10.32 as a reliable cost baseline. To avoid unexpected charges, individuals should request an itemized bill prior to payment to ensure no unbundled codes or services not rendered are included, and they should consider signing a waiver of insurance submission if paying cash directly to secure the lowest possible rate.