Culture, blood
Facility: Mercy Hospital Columbus
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $52
- Cash Discount Price: $46
- vs. Medicare Baseline: 5.04x 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 504% of the Medicare baseline (a markup of 404%). 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 | $9 - $52 | 87% |
| Humana | $9 - $67 | 87% |
| Medicaid / KanCare | $9 - $52 | 87% |
| UnitedHealthcare | $9 - $59 | 87% |
| Novasys Contracted [320285] | $10 | 97% |
| Medicare (plans) | $10 - $54 | 97% |
| Health Systems Inc Contracted [320174] | $31 | 300% |
| Insurance System Inc Contracted [320465] | $31 | 300% |
| Administrative Payor Contracted [320005] | $32 | 310% |
| Ambetter / Centene | $52 | 504% |
| Cigna | $52 | 504% |
| Mercy Hospice Okc [20252] | $52 | 504% |
| Halo Hcr Inc Hospice Contracted [320432] | $52 | 504% |
| Kindful Hospice [20434] | $52 | 504% |
| Globalhealth Contracted [320145] | $52 | 504% |
| Pace Of The Ozarks Contracted [320518] | $52 | 504% |
| Dept Of Veteran Affairs Contracted [320106] | $52 | 504% |
| Cross Timbers Hospice [20098] | $52 | 504% |
| Medical Associates Health Contracted [320444] | $52 | 504% |
| Tricare | $52 | 504% |
| Home State Health Plan Contracted [320187] | $52 | 504% |
| Indian Health Service Contracted [320198] | $52 | 504% |
| Qual Choice Contracted [320325] | $52 | 504% |
| Kindful Hospice Contracted [320434] | $52 | 504% |
| Provider Partners Health Plans Contracted [320450] | $52 | 504% |
| Centurion Of Missouri [20459] | $52 | 504% |
| Cherokee Nation Health Serv Contracted [320066] | $52 | 504% |
| Elara Caring Aspire Hospice [20433] | $52 | 504% |
| Halo Hcr Inc Hospice [20432] | $52 | 504% |
| Aetna | $52 - $64 | 504% |
| Mercy Mgd Behavioral Health Contracted [320259] | $52 | 504% |
| Healthscope Contracted [320182] | $55 | 533% |
| Workers Comp [20426] | $57 - $60 | 552% |
| United Medical Resources Contracted [320454] | $59 - $67 | 572% |
| First Health Contracted [320128] | $64 | 620% |
| Mercy Benefit Admin Contracted [320251] | $64 - $67 | 620% |
| American Healthcare Alliance Contracted [320020] | $64 | 620% |
| Medica Contracted [320239] | $64 | 620% |
| Federal Medical Center Contracted [320127] | $64 | 620% |
| Preferred Health Plan Contracted [320522] | $64 | 620% |
| Usa Managed Care Org Contracted [320429] | $64 | 620% |
| Healthlink Contracted [320179] | $64 - $67 | 620% |
| Aither Health Contracted [320449] | $67 | 649% |
| Edison Health Solutions Contracted [320502] | $67 | 649% |
| Benefit Management Contracted [320052] | $67 | 649% |
| Ppo Plus Contracted [320310] | $67 | 649% |
| Show-Me Health Administrators Contracted [320483] | $67 | 649% |
| Reflect Health Contracted [320492] | $67 | 649% |
| Imagine 360 Contracted [320494] | $67 | 649% |
| Point C Contracted [320238] | $67 | 649% |
| 90 Degree Benefits Contracted [320436] | $67 | 649% |
| Private Health Care Systems Contracted [320320] | $67 | 649% |
| Auxiant Contracted [320462] | $67 | 649% |
| Yuzu Health Contracted [320521] | $67 | 649% |
| Ebms Contracted [320493] | $67 | 649% |
Consumer Guidance & Cost Commentary
For this blood culture service at Mercy Hospital Columbus, the facility's cash price of $46.00 is significantly lower than the average negotiated rates paid by major insurers, which range from $9.00 to $67.00 depending on the plan. While the facility's cash rate is also lower than the state average of $52.00, patients with high-deductible plans may find the cash price more affordable if their insurance negotiated rate exceeds this amount. It is important to note that the facility's cash rate is still higher than the Medicare benchmark of $10.32, which serves as a baseline for the true cost of care. Because the facility is a Critical Access Hospital, patients should proactively ask about self-pay or prompt-pay discounts before scheduling, as these upfront payment incentives can further reduce the final bill by bypassing administrative fees and insurance processing costs.
The data reveals a wide variation in pricing across different payers, with some contracted entities charging as high as $67.00, while others, including Medicaid/KanCare and several hospice contracts, charge the same as the cash price of $52.00. This disparity highlights that being "in-network" does not guarantee the lowest possible price, as different insurance plans negotiate different rates. To avoid unexpected costs, patients should request an itemized bill to verify that no balance billing is occurring for out-of-network ancillary services, even at this in-network facility. If a bill arrives that includes charges exceeding the allowed amount, patients should dispute it in writing rather than paying immediately, as federal protections like the No Surprises Act may prevent balance billing for emergency or non-emergency services provided at in-network hospitals.