Culture, blood
Facility: Medicine Lodge Memorial Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $49
- Cash Discount Price: $52
- vs. Medicare Baseline: 4.75x 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 475% of the Medicare baseline (a markup of 375%). 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 |
|---|---|---|
| Tricare | $40 - $43 | 388% |
| Humana | $46 - $49 | 446% |
| Aetna | $47 - $54 | 455% |
| UnitedHealthcare | $48 - $51 | 465% |
| Hpk-All Plans | $48 - $51 | 465% |
| Medicaid / KanCare | $51 - $54 | 494% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood) at Medicine Lodge Memorial Hospital in Medicine Lodge, KS, the cash price is $52.00, which matches the facility's median negotiated rate. This cash price is significantly lower than the state average for this service, offering a clear opportunity for cost savings if you are self-paying. While commercial payers like Aetna and UnitedHealthcare negotiate rates ranging from $47 to $54, these amounts often exceed the cash price due to administrative overhead and contract structures. If you have a high-deductible plan, paying the $52.00 cash rate upfront may be more affordable than your insurance allowing a higher negotiated amount, especially if you have not yet met your deductible.
To ensure you are receiving the best possible rate, it is critical to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, you should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full within a short window, bypassing costly insurance claims processing. Since the facility is a Critical Access Hospital owned by a Government Hospital District, verify that your specific plan is in-network to avoid unexpected balance billing, though the No Surprises Act protects you from out-of-network charges for emergency services at in-network facilities. Always compare the final allowed amount against the Medicare rate of $10.32 to confirm the facility is charging a fair markup rather than relying on inflated chargemaster lists.