Culture, blood
Facility: Kiowa District Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $72
- Cash Discount Price: $61
- vs. Medicare Baseline: 6.98x 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 698% of the Medicare baseline (a markup of 598%). 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 |
|---|---|---|
| Healthchoice-All Plans | $15 | 145% |
| Tricare | $30 | 291% |
| Blue Cross Blue Shield | $38 | 368% |
| UnitedHealthcare | $61 - $76 | 591% |
| Health Partners Of Ks-All Plans | $67 | 649% |
| Humana | $69 | 669% |
| Gbs Insurance - All Plans | $71 | 688% |
| Multiplan-All Plans | $71 | 688% |
| Aetna | $72 | 698% |
| Triwest-All Plans | $72 | 698% |
| Medicare (plans) | $72 | 698% |
| Medicaid / KanCare | $76 | 736% |
| Providers Care (Wppa)-All Plans | $114 | 1105% |
| Liberty Healthshare-All Plans | $123 | 1192% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood), Kiowa District Hospital in Kiowa, KS, lists a gross charge of $76.00. While the facility's cash median rate is $61.00, which is lower than the negotiated rates paid by most major insurers, patients should be aware that commercial insurance contracts often result in higher out-of-pocket costs due to administrative fees and deductible requirements. For instance, UnitedHealthcare's negotiated range spans $61.00 to $76.00 across three plans, while Medicaid/KanCare pays the full $76.00. Because the cash price is frequently lower than the insurer's allowed amount, individuals with high-deductible plans may save money by paying the self-pay rate directly, provided they verify the facility's specific "self-pay" or "prompt-pay" discounts before scheduling.
The facility's pricing is significantly higher than the Medicare benchmark, which stands at $10.32 for this service. This substantial difference highlights the markup inherent in commercial billing structures, where negotiated rates can average 200% to 300% of the Medicare rate. Although the data does not provide specific state or county average comparisons for this exact code, the disparity between the government-set Medicare rate and the commercial charges underscores the importance of understanding the true cost baseline. Consumers are advised to request an itemized billing audit to ensure no errors exist, as over 80% of hospital bills contain mistakes such as unbundled codes or services not rendered. Additionally, if a patient receives care from an out-of-network provider at this Critical Access Hospital, they may be protected from balance billing for emergency services under