Culture, blood
Facility: Jewell County Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $143
- Cash Discount Price: $113
- vs. Medicare Baseline: 13.86x 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 1386% of the Medicare baseline (a markup of 1286%). 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 |
|---|---|---|
| Rural Carriers - All Plans | $128 | 1240% |
| Meritain - All Plans | $135 | 1308% |
| Aetna | $135 | 1308% |
| UnitedHealthcare | $142 | 1376% |
| First Health - All Plans | $142 | 1376% |
| Midlands Choice - All Plans | $142 | 1376% |
| Cigna | $142 | 1376% |
Consumer Guidance & Cost Commentary
For the blood culture service (CPT 87040) at Jewell County Hospital in Mankato, KS, the negotiated rates for in-network payers range from $128 to $142, while the cash price is $113. This cash rate is notably lower than the facility's negotiated rates, which aligns with the state average for this procedure. Because the cash price is lower than the insurance negotiated amounts, patients with high-deductible plans may save money by paying out-of-pocket directly, provided they have sufficient funds. It is important to note that while the facility is a Critical Access Hospital with government ownership, the cash rate of $113 does not include the administrative overhead that typically inflates commercial insurance rates by 20% to 40%.
To maximize savings, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final cost. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is still advisable to request a full itemized bill to verify that no unbundled codes or services not rendered have been charged. For context, the Medicare benchmark for this service is $10.32, which serves as a baseline for fair pricing; commercial rates are often significantly higher due to contract dynamics, but the cash option here offers a more transparent and potentially lower cost than the standard insurance negotiated ceiling.