Culture, blood
Facility: Kansas Spine & Specialty Hospital, Llc
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $10
- Cash Discount Price: $76
- 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 |
|---|---|---|
| Humana | $10 | 97% |
| Blue Cross Blue Shield | $10 | 97% |
| Aetna | $10 - $13 | 97% |
| UnitedHealthcare | $10 - $12 | 97% |
| Providrs Care Network | $10 | 97% |
| United Mine Workers Of America | $10 | 97% |
| Lantern Specialty Care | $17 | 165% |
Consumer Guidance & Cost Commentary
For the "Culture, blood" procedure (CPT 87040) at Kansas Spine & Specialty Hospital, Llc in Wichita, KS, the cash median price is $76.00, which is significantly lower than the facility's gross charge of $116.00. This cash rate is notably higher than the Medicare benchmark of $10.32, reflecting the true cost of service delivery rather than the inflated chargemaster list. While the facility's negotiated rates with major payers like Humana and Blue Cross Blue Shield average $10.00, these amounts are still well above the Medicare baseline and may not represent the lowest possible cost for patients. Patients with high-deductible plans or those without insurance should consider paying cash directly, as the $76.00 rate avoids the administrative overhead and markup often associated with insurance billing cycles.
To ensure you receive the most accurate pricing, it is essential to verify your specific plan's allowed amount and ask the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill. If you are using insurance, be aware that balance billing could occur if an out-of-network provider bills you for the difference between their full charge and what your insurer pays, though the No Surprises Act protects you from such unexpected costs for emergency and non-emergency services at in-network facilities. For the most precise financial planning, request a detailed, itemized bill that breaks down every CPT code and charge, as summary bills often obscure individual line items. Always confirm your deductible status before scheduling, as paying the negotiated rate may not be necessary if your plan covers the service after your deductible is met.