Culture, blood
Facility: Clara Barton Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $93
- Cash Discount Price: $73
- vs. Medicare Baseline: 9.01x 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 901% of the Medicare baseline (a markup of 801%). 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 | 368% |
| 6 Degrees Health - All Plans | $72 - $74 | 698% |
| Wppa-All Plans | $82 - $85 | 795% |
| UnitedHealthcare | $93 - $95 | 901% |
| Phcs - All Plans | $93 - $95 | 901% |
| Aetna | $93 - $95 | 901% |
| Hlth Partners Of Ks-All Plans | $95 - $98 | 921% |
Consumer Guidance & Cost Commentary
For the blood culture service (CPT 87040) at Clara Barton Hospital in Hoisington, KS, the negotiated rates for in-network insurance plans range from $38 to $98, with a median negotiated amount of $93. This facility is a Critical Access Hospital with a voluntary non-profit ownership structure. While the cash price is $73, which is lower than the median negotiated rate of $93, patients with high-deductible plans may find paying cash upfront more beneficial than using insurance, as the insurance allowed amount often exceeds the cash price. It is important to note that prompt-pay discounts, which can reduce bills by 20% to 50% for upfront payment, are not explicitly listed in the provided data; however, patients should always ask the billing department about self-pay or prompt-pay rates before scheduling to potentially lower their out-of-pocket costs.
The Medicare benchmark for this service is $10.32, which serves as a baseline for evaluating the facility's pricing markup. The gross charge of $105 is significantly higher than the Medicare amount, and the median paid amount by insurers is $84. While specific county or state average comparisons are not included in the provided dataset, the facility's location in Hoisington (ZIP 67544) and its status as a Critical Access Hospital are relevant factors in understanding regional pricing dynamics. Consumers should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though unexpected charges can still occur if ancillary services like lab work are billed out-of-network. To avoid surprises, patients should request a detailed, itemized bill