Culture, blood
Facility: Wichita County Health Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $57
- Cash Discount Price: $50
- vs. Medicare Baseline: 5.52x 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 552% of the Medicare baseline (a markup of 452%). 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 |
|---|---|---|
| Medicaid / KanCare | $51 | 494% |
| UnitedHealthcare | $62 | 601% |
Consumer Guidance & Cost Commentary
For the "Culture, blood" procedure (CPT 87040) at Wichita County Health Center in Leoti, Kansas, the facility's cash median rate of $50.00 is lower than the state average of $51.00. While Medicaid/KanCare members pay the full list price of $51.00 due to a lack of a negotiated contract, UnitedHealthcare members are covered under a negotiated rate of $62.00. This example illustrates how cash prices can sometimes be more affordable than insurance negotiated rates; patients with high-deductible plans may save money by paying the cash price directly, provided they verify that their specific insurance plan does not require them to pay the higher negotiated amount first.
To ensure you receive the most accurate pricing, it is important to distinguish between the facility's gross charge and the actual amount billed. The gross charge of $62.00 represents the maximum price before any discounts, whereas the cash median of $50.00 reflects the typical discounted rate for self-pay patients. If you are self-paying, you should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can further reduce the cost by 20% to 50% if paid upfront. Additionally, if you have insurance, be aware that the No Surprises Act protects you from balance billing for out-of-network services at in-network facilities, and you should always request an itemized bill to verify that no unbundled codes or services not rendered have inflated your total.