Culture, blood
Facility: Mcpherson Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $113
- Cash Discount Price: $127
- vs. Medicare Baseline: 10.95x 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 1095% of the Medicare baseline (a markup of 995%). 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 |
|---|---|---|
| Tricare | $9 | 87% |
| Blue Cross Blue Shield | $10 | 97% |
| Va Ccn - All Plans | $10 | 97% |
| Humana | $10 | 97% |
| Wellcare Mcr Adv - All Plans | $10 | 97% |
| Healthy Blue Mcr Adv | $10 | 97% |
| UnitedHealthcare | $10 - $227 | 97% |
| Ambetter / Centene | $12 | 116% |
| Wppa - All Plans | $81 - $159 | 785% |
| Central Plains - All Plans | $87 - $170 | 843% |
| Medical Associates - All Plans | $87 - $170 | 843% |
| Christian Health Aid - All Plans | $93 - $182 | 901% |
| Aetna | $96 - $227 | 930% |
| Multiplan - All Plans | $104 - $204 | 1008% |
| Cigna | $110 - $216 | 1066% |
| First Health - All Plans | $110 - $216 | 1066% |
| Health Partners - All Plans | $110 - $216 | 1066% |
| Medicaid / KanCare | $116 - $227 | 1124% |
| Health Blue Mcaid - All Other Plans | $118 - $232 | 1143% |
Consumer Guidance & Cost Commentary
For the CPT code 87040, "Culture, blood," McPherson Hospital in McPherson, KS, lists a cash median price of $127.00, which is notably lower than the facility's negotiated rates. While the hospital's cash price is competitive, the data indicates that commercial payers like UnitedHealthcare and Aetna negotiate rates as high as $227.00, suggesting that paying out-of-pocket may result in significant savings compared to using insurance for this specific service. Patients should verify their plan's deductible status before scheduling, as high negotiated rates can sometimes be offset by lower cash prices if the patient's insurance has not yet met its deductible threshold.
The facility's pricing structure aligns closely with state and county averages, with a Medicare benchmark of $10.32 serving as a baseline for evaluating markup. Although the facility is a voluntary non-profit acute care hospital, its negotiated rates for this procedure range widely across different insurers, with some plans paying up to $232.00. To ensure you receive the most favorable rate, it is recommended to request a self-pay or prompt-pay discount directly from the billing department before check-in, as these upfront payment incentives can further reduce the final cost. Additionally, if you receive an itemized bill, review it carefully to ensure no unbundled charges or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected through a formal audit dispute.