Culture, blood
Facility: Hamilton County Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $58
- Cash Discount Price: $65
- vs. Medicare Baseline: 5.62x 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 562% of the Medicare baseline (a markup of 462%). 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 | $18 - $38 | 174% |
| First Health Coventry - All Plans | $55 | 533% |
| Cigna | $61 | 591% |
| UnitedHealthcare | $61 | 591% |
| Va Ccn - All Plans | $65 | 630% |
| Aetna | $110 | 1066% |
Consumer Guidance & Cost Commentary
For this blood culture service at Hamilton County Hospital in Syracuse, KS, the cash price of $65.00 is significantly higher than the state average, which is $10.32. While the facility's negotiated rates for commercial payers range from $18 to $110, the cash price remains the lowest option available in this dataset. Patients with high-deductible plans or those without insurance may find it financially advantageous to pay the $65.00 cash price directly, as it avoids the administrative overhead and potential markups often embedded in insurance negotiated rates. To secure the best possible price, we recommend contacting the hospital directly to inquire about self-pay or prompt-pay discounts, which can further reduce the final amount owed.
It is important to distinguish between the gross charge of $65.00 and the actual amounts paid by insurers, which vary widely from $18 to $110 depending on the specific plan. Although the median negotiated rate is $61.00, this does not guarantee the lowest cost for every patient, as some payers may have higher allowed amounts. Because the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, you should not be surprised by additional charges for this specific service. However, if you receive an itemized bill, we strongly advise requesting a full line-by-line audit to ensure no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected.