Culture, blood
Facility: Lane County Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $69
- Cash Discount Price: $69
- vs. Medicare Baseline: 6.69x 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 669% of the Medicare baseline (a markup of 569%). 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 | $62 - $69 | 601% |
| Aetna | $62 - $66 | 601% |
| Healthy Blue Mcaid | $69 | 669% |
| Medicaid / KanCare | $69 - $76 | 669% |
| Healthy Blue Mcr Adv - All Other Plans | $69 | 669% |
| Wppa Providers-All Plans | $104 | 1008% |
Consumer Guidance & Cost Commentary
For the CPT code 87040, Culture, blood, Lane County Hospital in Dighton, KS, lists a cash median price of $69.00, which matches the facility's negotiated median rate. This price is significantly lower than the gross charge of $69.00 listed in the data, though it is important to note that the provided data shows the gross amount as $69.00, meaning there is no markup difference between the listed gross and the cash/negotiated rates in this specific record. The facility, a Critical Access Hospital owned by a Government Hospital District, has a Medicare amount of $10.32. While the data does not explicitly provide state or county average benchmarks for comparison, the facility's cash rate of $69.00 is notably higher than the Medicare benchmark of $10.32, illustrating the standard administrative markup inherent in commercial billing structures.
Patients should be aware that while cash payment of $69.00 is the baseline, insurance plans like UnitedHealthcare, Aetna, and Medicaid/KanCare have negotiated rates ranging from $62.00 to $104.00 depending on the specific plan. For individuals with high-deductible plans, paying the cash price of $69.00 upfront may be more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if the deductible has not been met or if the negotiated rate exceeds the cash price. To ensure you receive the best possible rate, it is recommended to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can further reduce the bill. Always request an itemized bill before