Culture, blood
Facility: Holton Community Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $54
- Cash Discount Price: $49
- vs. Medicare Baseline: 5.23x 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 523% of the Medicare baseline (a markup of 423%). 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 |
|---|---|---|
| Kansas Superior Select - All Plans | $35 | 339% |
| UnitedHealthcare | $35 - $66 | 339% |
| Humana | $35 | 339% |
| Aetna | $35 - $66 | 339% |
| Blue Cross Blue Shield | $38 | 368% |
| Preferred Health Freedom | $54 | 523% |
| Preferred Health Fn Select - All Other Plans | $54 | 523% |
| Preferred Health Professionals | $54 | 523% |
| Wppa Providers - All Plans | $62 | 601% |
| Medicaid / KanCare | $66 | 640% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood) at Holton Community Hospital in Holton, Kansas, the facility's cash median price is $49.00, which is lower than the gross charge of $66.00. While the hospital's negotiated rates for in-network payers range from $35.00 to $66.00, the cash price of $49.00 is notably lower than the median negotiated rate of $54.00. This suggests that patients with high-deductible plans or those without insurance may save money by paying cash directly, as the cash price is cheaper than the average amount insurance companies are willing to pay. However, patients should verify their specific plan's deductible status before assuming they will pay less out-of-pocket, as some commercial payers may still cover the full negotiated amount even if the cash price is lower.
The facility's pricing is also significantly lower than the Medicare benchmark for this service, which is $10.32. Although this comparison highlights a large gap between the cash price and the federal baseline, it is important to note that commercial negotiated rates often exceed Medicare rates due to administrative costs and contract structures. For patients concerned about unexpected costs, it is advisable to request a prompt-pay discount if paying in full, which can further reduce the bill. Additionally, patients should ensure they receive an itemized bill rather than a summary invoice to avoid potential errors or double-charging, and they should be aware that federal protections like the No Surprises Act may prevent balance billing for out-of-network services at this in-network facility.