Culture, blood
Facility: Wesley Medical Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $22
- Cash Discount Price: $1,572
- vs. Medicare Baseline: 2.13x 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 213% of the Medicare baseline (a markup of 113%). 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 | $9 | 87% |
| Coventry Health Care | $10 | 97% |
| Aetna | $10 - $561 | 97% |
| Amerigroup | $10 | 97% |
| Humana | $10 | 97% |
| Medicaid / KanCare | $10 | 97% |
| United | $10 - $707 | 97% |
| Devoted Health | $10 | 97% |
| Ambetter / Centene | $11 - $283 | 107% |
| Triwest Health Alliance | $11 | 107% |
| Correct Care Solutions | $15 | 145% |
| First Health | $22 - $725 | 213% |
| Multiplan | $22 - $1,415 | 213% |
| Blue Cross Blue Shield | $27 | 262% |
| Health Partners Of Kansas | $272 - $786 | 2636% |
| Wppa | $274 | 2655% |
| Medical Associates Health Plan | $297 | 2878% |
| Preferred Health Choices | $297 | 2878% |
| Spirit Aerosystems | $503 | 4874% |
| Triwest Healthcare Alliance | $1,022 | 9903% |
| Usa Managed Care | $1,336 | 12946% |
Consumer Guidance & Cost Commentary
For CPT code 87040, "Culture, blood," at Wesley Medical Center in Wichita, KS, the cash price is $1,572.00, which matches the facility's cash median. This rate is significantly higher than the Medicare benchmark of $10.32, reflecting a markup of 2.1 times the federal baseline. While the facility offers a negotiated rate of $22.00 for in-network plans, this amount is still 21 times higher than the Medicare amount. Patients with high-deductible plans may find paying the cash price directly more cost-effective than using insurance, as the negotiated rates for many payers (ranging from $9 to $1,336 depending on the plan) often exceed the cash price. It is important to note that cash payments can sometimes result in lower out-of-pocket costs if the insurance negotiated rate is higher than the cash charge.
To minimize potential costs, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling or receiving services, as these upfront payment incentives can reduce the bill by 20% to 50%. Additionally, patients should request a full itemized bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If a patient receives a balance bill from an out-of-network provider, they may be protected under the No Surprises Act, which bans balance billing for emergency care and non-emergency services at in-network facilities. Always verify your specific plan's deductible status and allowed amounts before proceeding, as paying the full negotiated rate may not be necessary if you have already