Culture, blood
Facility: Ellsworth County Medical Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $113
- Cash Discount Price: $125
- vs. Medicare Baseline: 10.95x 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 1095% of the Medicare baseline (a markup of 995%). 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 | $36 - $38 | 349% |
| Humana | $59 - $119 | 572% |
| Va Ccn-All Plans | $59 | 572% |
| Healthy Blue Mcr Adv | $59 | 572% |
| Triwest -All Plans | $59 | 572% |
| UnitedHealthcare | $81 - $125 | 785% |
| Aetna | $112 | 1085% |
| First Health - All Plans | $112 | 1085% |
| Cigna | $119 | 1153% |
| Medicaid / KanCare | $125 | 1211% |
| Healthy Blue Mcaid- All Other Plans | $125 | 1211% |
| Coventry Mcaid-All Plans | $125 | 1211% |
| Providers Care-Wppa-All Plans | $188 | 1822% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood), Ellsworth County Medical Center in Ellsworth, KS, lists a gross charge of $125.00. This amount aligns with the cash median of $125.00 and the Medicare amount of $10.32, representing a markup of 10.9 times the Medicare rate. While the facility's negotiated rates for in-network payers range from $36 to $125, with a median negotiated rate of $113.00, patients should be aware that paying cash upfront may result in a lower total cost than using insurance, particularly if their plan has a high deductible. The facility offers a prompt-pay discount for upfront payments, which can bypass administrative claim processing fees and provide immediate liquidity benefits to the patient.
Insurance coverage varies significantly across the 13 payers listed, with allowed amounts spanning from $36 for Blue Cross Blue Shield to $188 for Providers Care-Wppa-All Plans. Although the facility is an in-network Critical Access Hospital, the wide disparity in negotiated rates suggests that specific plan contracts heavily influence out-of-pocket costs. Patients are advised to request a formal itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, patients should verify their specific plan details and ask the billing department about any self-pay or prompt-pay discounts prior to scheduling to avoid unexpected charges.