Culture, blood
Facility: Pratt Regional Medical Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $68
- Cash Discount Price: $55
- vs. Medicare Baseline: 6.59x 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 659% of the Medicare baseline (a markup of 559%). 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 |
|---|---|---|
| Christian Health Aid | $59 | 572% |
| UnitedHealthcare | $65 - $80 | 630% |
| Health Partners Of Kansas | $66 | 640% |
| Aetna | $70 | 678% |
| Choicecare | $78 | 756% |
Consumer Guidance & Cost Commentary
For the "Culture, blood" procedure (CPT 87040) at Pratt Regional Medical Center in Pratt, KS, the cash median price is $55.00, which is lower than the facility's gross charge of $78.00. While the facility's negotiated rates with major payers like UnitedHealthcare and Aetna range from $65 to $80, these amounts are often higher than the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find paying the cash median of $55.00 upfront more cost-effective than relying on insurance, which could result in a negotiated rate exceeding the cash price. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront incentives can further reduce the final cost.
When evaluating this price, it is important to compare it against the Medicare benchmark rather than the hospital's full list price. The Medicare amount for this service is $10.32, and the facility's cash rate of $55.00 represents a 6.6% markup over this federal baseline, which aligns with fair pricing standards typically defined between 120% and 150% of Medicare. If a patient receives care from an out-of-network provider or encounters unexpected ancillary services, they may face balance billing for the difference between the allowed amount and the full charge; however, the No Surprises Act protects patients from such surprise bills for emergency and non-emergency services at in-network facilities. To ensure accuracy, patients should request a detailed, itemized bill to verify that all charges correspond to services