Culture, blood
Facility: Rooks County Health Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $107
- Cash Discount Price: $89
- vs. Medicare Baseline: 10.37x 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 1037% of the Medicare baseline (a markup of 937%). 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% |
| Veterans Admin - All Plans | $56 | 543% |
| Celtic Mcr Adv | $56 | 543% |
| Tricare | $56 | 543% |
| Celtic Comm - All Other Plans | $62 | 601% |
| Preferred Benefits Admin | $107 | 1037% |
| Aetna | $107 | 1037% |
| UnitedHealthcare | $107 | 1037% |
| Health Partners - All Plans | $113 | 1095% |
| Preferred Hlthcare - All Other Plans | $113 | 1095% |
| Healthy Blue Mcaid - All Plans | $119 | 1153% |
Consumer Guidance & Cost Commentary
This CPT code for a blood culture at Rooks County Health Center in Plainville, Kansas, carries a gross charge of $119.00, with a cash median price of $89.00. For patients without insurance, paying the cash median rate of $89.00 is generally the most cost-effective option, as it is lower than the facility's negotiated rates of $107.00 paid by insurance plans. While the facility is a Critical Access Hospital owned by a Government Hospital District, the cash price remains the primary benchmark for self-pay patients. It is important to note that while cash rates are often lower, some patients with high-deductible plans may find the negotiated rate of $107.00 more favorable if their insurance deductible has not yet been met, as they would be responsible for the full negotiated amount rather than the cash price.
The facility's negotiated rates of $107.00 are consistent across all 11 payer plans listed, ranging from Veterans Admin to UnitedHealthcare, and do not vary by plan type. These rates are significantly higher than the Medicare benchmark of $10.32, reflecting the standard commercial markup structure where negotiated rates typically exceed Medicare rates by a substantial margin. Patients should be aware that while the No Surprises Act protects against balance billing for emergency services at in-network facilities, it does not apply to routine outpatient procedures like blood cultures. To minimize costs, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these programs can offer additional reductions beyond the standard cash median. Furthermore, if a patient receives an itemized bill, they should request a full line-by-line audit to