Culture, blood
Facility: Kiowa County Memorial Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $143
- Cash Discount Price: $137
- vs. Medicare Baseline: 13.86x 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 1386% of the Medicare baseline (a markup of 1286%). 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 | $38 - $143 | 368% |
| UnitedHealthcare | $129 - $161 | 1250% |
| Health Partners Of Ks-All Plans | $142 | 1376% |
| Celtic Comml Exchange-All Other Plans | $143 | 1386% |
| Aetna | $143 | 1386% |
| Humana | $143 | 1386% |
| Medica Prime Mcare Cost-All Plans | $143 | 1386% |
| Medicaid / KanCare | $161 | 1560% |
| Providrs Care/Wppa-All Plans | $242 | 2345% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood) at Kiowa County Memorial Hospital in Greensburg, KS, the facility's cash median rate is $137.00, which is lower than the negotiated rates paid by most major insurers. While the facility's cash price sits below the gross charge of $161.00, it is important to note that many commercial payers, including UnitedHealthcare and Medicaid/KanCare, negotiate rates that match or exceed the cash price, ranging from $129.00 to $161.00. This dynamic suggests that for patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price directly could result in lower total costs compared to using insurance, as the insurer's allowed amount may be higher than the cash rate.
The facility's pricing structure is anchored by a Medicare benchmark of $10.32, which serves as the objective baseline for evaluating the markup on this service. Commercial negotiated rates for this procedure average significantly higher than the Medicare rate, reflecting the administrative costs and contract dynamics inherent in insurance billing. Patients should be aware that while the facility is a Critical Access Hospital with government-local ownership, they can often reduce their out-of-pocket expenses by requesting a "prompt-pay" discount or verifying "self-pay" rates before scheduling. It is also advisable to review any itemized bill for potential errors, as over 80% of hospital bills contain discrepancies such as unbundled codes or services not rendered, and to dispute any balance billing immediately if it arises from an out-of-network scenario, as federal protections like the No Surprises Act may apply.