Culture, blood
Facility: Wamego Health Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $10
- Cash Discount Price: $121
- vs. Medicare Baseline: 0.97x 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.
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 |
|---|---|---|
| UnitedHealthcare | $9 | 87% |
| Aetna | $10 | 97% |
| Providrs Care | $10 | 97% |
| Medicaid / KanCare | $10 | 97% |
| Blue Cross Blue Shield | $224 - $308 | 2171% |
Consumer Guidance & Cost Commentary
For the "Culture, blood" procedure (CPT 87040) at Wamego Health Center in Wamego, KS, the facility's cash median price is $121.00, which is significantly lower than the gross charge of $303.00. While the facility is in-network for UnitedHealthcare, Aetna, Providrs Care, and Medicaid/KanCare, the negotiated rates for these plans are extremely low, ranging from $9 to $10. This suggests that for patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price of $121.00 upfront may be more cost-effective than relying on insurance, which could result in a higher allowed amount if the negotiated rate exceeds the cash price. Additionally, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill.
The facility's pricing is benchmarked against the Medicare rate of $10.32, which serves as a baseline for the true cost of care. Although the data does not provide specific county or state average comparisons for this specific code, the significant gap between the Medicare rate and the cash price highlights the potential for substantial savings through direct payment. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still request an itemized bill to ensure no unbundled charges or services not rendered are included. If a patient receives a summary bill, they should demand a full line-by-line statement to identify any errors before agreeing to pay, as