Culture, blood
Facility: Kansas City Orthopaedic Institute
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $19
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.84x 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 | $10 | 97% |
| Cigna | $10 - $91 | 97% |
| UnitedHealthcare | $10 - $106 | 97% |
| Blue Cross Blue Shield | $19 - $116 | 184% |
| Medica | $100 | 969% |
Consumer Guidance & Cost Commentary
For the "Culture, blood" procedure at Kansas City Orthopaedic Institute in Leawood, KS, the facility's negotiated rates range from $10 to $116 across five major payers, with a median negotiated payment of $19.00. This facility is owned by a physician group and operates as an acute care hospital. While the gross charge listed is $181.00, the actual amount paid by insurers is significantly lower, reflecting standard contract caps. It is important to note that cash-pay options are not available for this specific service, as the data indicates no cash or median paid rates were reported. Patients should be aware that even though insurance negotiates a lower rate than the gross charge, the final out-of-pocket cost depends entirely on their individual deductible and co-insurance levels.
When evaluating costs, it is crucial to understand that commercial negotiated rates often include administrative overhead for claims processing, which can inflate the baseline price compared to the true cost of care. In this instance, the Medicare benchmark rate for this procedure is $10.32, which serves as a scientifically validated baseline for the "true cost" of delivery. While the data does not provide specific state or county average comparisons for this exact procedure, patients should generally expect that commercial rates will be higher than Medicare due to the inclusion of network management and billing infrastructure. If a patient has a high-deductible plan, they should verify whether their specific insurance allowed amount exceeds the facility's cash price, as paying out-of-pocket could sometimes be more expensive than the insurance negotiated rate. Finally, since this is an in-network facility, the No Surprises Act protects patients from balance billing for out-of-network services rendered at this location