Culture, blood
Facility: Grisell Memorial Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $51
- Cash Discount Price: $83
- vs. Medicare Baseline: 4.94x 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 494% of the Medicare baseline (a markup of 394%). 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 - $65 | 87% |
| Blue Cross Blue Shield | $36 | 349% |
| Humana | $88 | 853% |
| Medicaid / KanCare | $88 | 853% |
Consumer Guidance & Cost Commentary
For this blood culture service at Grisell Memorial Hospital in Ransom, KS, the cash price of $83.00 is notably lower than the facility's negotiated rates with major payers, which range from $36.00 to $88.00 depending on the specific insurance plan. While the median negotiated rate across all payers is $51.00, the cash price remains competitive and aligns closely with the facility's own cash median. It is important to note that for patients with high-deductible plans, paying the cash price of $83.00 upfront may be more cost-effective than relying on insurance, as the insurer's allowed amount could exceed the cash rate, potentially leading to balance billing if the service is out-of-network. Additionally, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing administrative claim processing fees.
When evaluating the cost of this service, it is crucial to compare rates against the Medicare benchmark rather than the hospital's gross chargemaster, which often inflates the perceived savings. The Medicare amount for this procedure is $10.32, providing a clear baseline for fair pricing; commercial negotiated rates typically average between 200% and 300% of this figure, though fair pricing is generally defined as 120% to 150%. Given that the facility is a Critical Access Hospital owned by a Government Hospital District, these rates reflect the specific cost structures and local wage indexes used in CMS calculations. To ensure you are not overcharged, we recommend requesting a full itemized billing audit before finalizing payment, as over 8