Culture, blood
Facility: F W Huston Medical Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $123
- Cash Discount Price: $128
- vs. Medicare Baseline: 11.92x 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 1192% of the Medicare baseline (a markup of 1092%). 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% |
| Aetna | $120 | 1163% |
| Humana | $126 | 1221% |
| Cigna | $136 | 1318% |
Consumer Guidance & Cost Commentary
For this blood culture service at F W Huston Medical Center in Winchester, KS, the facility's cash price of $128.00 is notably higher than the state average of $10.32, reflecting the specific cost structure of this Critical Access Hospital. While the facility offers a median negotiated rate of $123.00 for in-network patients, this amount remains significantly above the Medicare benchmark of $10.32, which serves as the objective baseline for fair pricing. It is important to note that for patients with high-deductible plans, paying the cash price of $128.00 upfront may actually be more cost-effective than using insurance, as the negotiated rate often exceeds the cash price due to administrative overheads included in commercial contracts.
To ensure you are receiving the most accurate and transparent pricing, we recommend requesting a full itemized bill before finalizing payment, as summary invoices can obscure individual charges and potential errors. If you choose to pay out-of-pocket, ask the billing department about "prompt-pay" discounts, which can reduce the total cost by 20% to 50% when settled within 30 days. Additionally, verify your specific plan's allowed amount for this code, as commercial payers like Blue Cross Blue Shield, Aetna, Humana, and Cigna have negotiated rates ranging from $38 to $136, but these figures may not apply to your individual deductible status or specific policy terms.