Culture, blood
Facility: Kansas Heart Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $10
- Cash Discount Price: $31
- vs. Medicare Baseline: 0.97x 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 |
|---|---|---|
| Aetna | $4 - $7 | 39% |
| Tricare | $9 | 87% |
| Medicaid / KanCare | $10 | 97% |
| Humana | $10 | 97% |
| Celtic Mcr Adv | $10 | 97% |
| UnitedHealthcare | $10 | 97% |
| Wppa - All Plans | $15 - $25 | 145% |
| Blue Cross Blue Shield | $26 | 252% |
| Multiplan - All Plans | $33 - $57 | 320% |
Consumer Guidance & Cost Commentary
For the blood culture service (CPT 87040) at Kansas Heart Hospital in Wichita, KS, the cash median price is $31.00, which is significantly lower than the state average of $50.00. While the facility's negotiated rates with major payers like Aetna, Tricare, and Medicaid range from $4 to $33, these amounts are often higher than the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash median of $31.00 directly, as this bypasses the insurance billing cycle and avoids potential balance billing if the insurer's allowed amount exceeds the cash rate. It is important to note that the facility offers a proprietary ownership model, and patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling to ensure they receive the most favorable upfront pricing available.
The facility's pricing is benchmarked against Medicare, with a Medicare amount of $10.32, which serves as a baseline for evaluating commercial markups. The median negotiated rate of $10.00 is slightly below the Medicare amount, suggesting competitive pricing relative to the federal standard, though individual payer contracts vary widely, with some plans like Multiplan - All Plans negotiating up to $57. Because over 80% of hospital bills contain errors, patients should always request a detailed, itemized bill rather than accepting a summary invoice. If a balance bill arises from out-of-network ancillary services, the No Surprises Act may provide protection, and patients should dispute any unexpected charges in writing rather than paying immediately out of fear. Always verify your specific plan's deductible status