Culture, blood
Facility: Rawlins County Health Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $100
- Cash Discount Price: $98
- vs. Medicare Baseline: 9.69x 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 969% of the Medicare baseline (a markup of 869%). 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 | $38 | 368% |
| UnitedHealthcare | $100 | 969% |
Consumer Guidance & Cost Commentary
For the CPT code 87040, representing a blood culture at Rawlins County Health Center in Atwood, Kansas, the cash median price is $98.00, which is notably lower than the facility's gross charge of $115.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the negotiated rates for in-network payers such as Blue Cross Blue Shield and UnitedHealthcare range from $38.00 to $100.00, depending on the specific plan. It is important to note that for patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price of $98.00 may result in lower total costs than using insurance, as the negotiated rates can sometimes exceed the cash price due to administrative overhead and contract dynamics.
When evaluating the value of this service, it is essential to compare rates against the Medicare benchmark rather than the hospital's gross list price. The Medicare amount for this procedure is $10.32, and the facility's negotiated rate of $100.00 represents a significant markup relative to this federal baseline, which is calculated using local wage indexes and actual provider costs. To maximize savings, patients should verify their specific plan's allowed amount before scheduling and inquire directly with the billing department about "self-pay" or "prompt-pay" discounts, which can further reduce the final balance. Additionally, since over 80% of hospital bills contain errors, requesting a detailed, itemized statement is a critical step to ensure no unbundled codes or services not rendered are included in the final invoice.