Culture, blood
Facility: Graham County Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $40
- Cash Discount Price: $55
- vs. Medicare Baseline: 3.88x 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 388% of the Medicare baseline (a markup of 288%). 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 |
|---|---|---|
| UnitedHealthcare | $6 - $52 | 58% |
| Medicaid / KanCare | $15 | 145% |
| Blue Cross Blue Shield | $38 | 368% |
| Medicare (plans) | $41 | 397% |
| Celtic Commercial-All Other Plans | $45 | 436% |
| Wppa (Providers Care)-All Plans | $52 | 504% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood) at Graham County Hospital in Hill City, KS, the cash price is $55.00, which matches the facility's median negotiated rate. This cash price is significantly lower than the state average for this service, which ranges from $6 to $52 across various payers, with the highest negotiated rates reaching $52. While commercial insurance plans like UnitedHealthcare and Wppa (Providers Care) have negotiated rates between $15 and $52, patients with high-deductible plans may find paying the $55.00 cash price directly more cost-effective than relying on insurance, especially if the insurer's allowed amount exceeds the cash rate. It is important to note that while the facility is a Critical Access Hospital owned by the local government, patients should always confirm "self-pay" or "prompt-pay" discounts with the billing department before scheduling to ensure they are not charged the full negotiated amount.
The Medicare benchmark for this procedure is $10.32, which serves as a critical baseline for understanding the facility's pricing markup. The cash price of $55.00 represents a substantial increase over the Medicare rate, reflecting the administrative costs and profit margins inherent in commercial billing structures. To avoid unexpected costs, patients should request an itemized billing audit if they receive a summary bill, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. Furthermore, if a patient encounters a balance bill from an out-of-network provider, they should not pay immediately; instead, they should dispute the charge with their insurer and request a No Surprises Act audit to protect against surprise