Culture, blood
Facility: Providence Medical Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $11
- Cash Discount Price: $10
- vs. Medicare Baseline: 1.07x 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.
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 |
|---|---|---|
| Medicaid / KanCare | $9 | 87% |
| UnitedHealthcare | $9 - $17 | 87% |
| Midland Care Connection | $10 | 97% |
| Healthy Blue | $10 - $11 | 97% |
| Aetna | $10 - $18 | 97% |
| Blue Cross Blue Shield | $10 - $25 | 97% |
| Cigna | $10 | 97% |
| Medicare (plans) | $10 | 97% |
| Celtic | $10 - $17 | 97% |
| Tricare | $10 | 97% |
| Kansas Superior Select | $11 | 107% |
| Corizon | $13 | 126% |
| Well Path Prison | $14 | 136% |
| Employer Direct Healthcare | $14 | 136% |
| Centurion | $15 | 145% |
| Naphcare | $16 | 155% |
| Comp Alliance - Fka Compresults Worker Compensation | $20 | 194% |
| Oha Networks | $22 | 213% |
| Worker Compensation | $23 | 223% |
Consumer Guidance & Cost Commentary
For the blood culture service (CPT 87040) at Providence Medical Center in Kansas City, KS, the facility's cash price of $10.00 is significantly lower than the state average of $115.00. While commercial insurance plans like UnitedHealthcare and Aetna negotiate rates ranging from $9 to $25, these negotiated amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. Because the cash rate is so low, it is advisable to ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the cost compared to standard billing cycles.
It is important to understand that commercial insurance rates are not set by the government but are contractually agreed-upon prices that include administrative overhead, often resulting in higher costs than the Medicare benchmark of $10.32. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still request a detailed, itemized bill to ensure no unbundled charges or errors exist, as over 80% of hospital bills contain mistakes. By comparing the facility's rates directly to the Medicare baseline rather than the inflated chargemaster list, consumers can better evaluate whether the negotiated or cash rates represent fair value for the service provided.