Culture, blood
Facility: Stormont Vail Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $31
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.00x 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 300% of the Medicare baseline (a markup of 200%). 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 |
|---|---|---|
| Ambetter / Centene | $10 | 97% |
| UnitedHealthcare | $10 | 97% |
| Blue Cross Blue Shield | $10 - $38 | 97% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood) at Stormont Vail Hospital in Topeka, KS, the facility's negotiated payment rate is $31.00, which is significantly lower than the median paid amount of $9145.00 observed across payers. This code is covered by three major insurers: Ambetter / Centene and UnitedHealthcare, both with a single plan, and Blue Cross Blue Shield, which covers five plans. While the facility is a voluntary non-profit acute care hospital, the data does not provide a specific cash price or a direct comparison to Kansas state or county averages for this procedure. However, the Medicare amount for this service is listed at $10.32, which serves as a critical baseline for understanding the facility's pricing structure relative to federal standards.
Patients should be aware that commercial negotiated rates often exceed cash prices due to administrative overhead and contract dynamics, meaning self-pay or prompt-pay discounts could result in lower out-of-pocket costs if the insurance allowed amount is high. Since the data indicates a median paid amount of $9145.00, it is important to verify your specific plan's deductible status before scheduling, as you may be responsible for paying the full negotiated rate if your deductible has not been met. To ensure you are receiving the most accurate and transparent pricing, always request a full itemized bill before finalizing payment to identify any unbundled codes or services not rendered, and confirm that any "savings" cited are calculated against the Medicare benchmark rather than the inflated hospital chargemaster list.