Culture, blood
Facility: Ellinwood District Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $49
- Cash Discount Price: $60
- vs. Medicare Baseline: 4.75x 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 475% of the Medicare baseline (a markup of 375%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $49 | 475% |
| Humana | $49 | 475% |
| Aetna | $49 | 475% |
| Cigna | $49 | 475% |
| UnitedHealthcare | $49 | 475% |
Consumer Guidance & Cost Commentary
For the blood culture service (CPT 87040) at Ellinwood District Hospital in Ellinwood, KS, the cash price of $60.00 is significantly lower than the negotiated rates of $49.00 paid by major insurers like Blue Cross Blue Shield and Humana. This facility, a Critical Access Hospital owned by a Government Hospital District, offers a cash median of $60.00, which is notably cheaper than the state average for this procedure. Because the cash price is lower than the insurance negotiated rate, patients with high-deductible plans may save money by paying out-of-pocket directly, provided they qualify for the cash price. It is important to note that while the facility is in-network for these payers, the cash option remains the most economical choice for this specific service.
Patients should be aware that commercial insurance rates often include administrative overhead and do not reflect the true cost of care, which is better represented by the Medicare benchmark of $10.32. While the facility's cash rate is higher than the Medicare amount, it is still a substantial discount compared to the full chargemaster gross of $71.00. To ensure you receive the best possible price, you should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these programs can offer additional reductions for upfront payment. If you receive a bill after using insurance, request an itemized audit to verify that no errors or unbundled charges exist, as over 80% of hospital bills contain mistakes that can be corrected.