Culture, blood
Facility: Great Plains Of Sabetha
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $50
- Cash Discount Price: $53
- vs. Medicare Baseline: 4.84x 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 484% of the Medicare baseline (a markup of 384%). 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 |
|---|---|---|
| Aetna | $28 - $53 | 271% |
| Celtic Mcr Adv | $28 | 271% |
| Celtic Comm Exchange-All Other Plans | $34 | 329% |
| Great West Healthcare-All Plans | $45 | 436% |
| UnitedHealthcare | $49 - $53 | 475% |
| Cigna | $50 | 484% |
| Multiplan-Phcs-All Plans | $50 | 484% |
| Century/Wppa/Providers-All Plans | $50 | 484% |
| Humana | $50 | 484% |
| Federated Mutual Ins-All Plans | $51 | 494% |
| Blue Cross Blue Shield | $53 | 514% |
| Medicaid / KanCare | $53 | 514% |
Consumer Guidance & Cost Commentary
For the "Culture, blood" procedure (CPT 87040) at Great Plains Of Sabetha in Sabetha, Kansas, the facility's cash median rate is $53.00, which matches the gross charge and is significantly higher than the state average of $40.00. While this cash price is the lowest available option among the 12 payers listed, it is important to note that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. For patients with high-deductible plans, paying the cash price of $53.00 upfront may result in lower out-of-pocket costs compared to insurance reimbursement, provided the patient's deductible has not yet been met. Patients should verify their specific plan's deductible status and ask the facility directly about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full before or shortly after the service.
The facility's negotiated rates vary widely by insurer, ranging from a low of $28.00 with Celtic Mcr Adv to a high of $53.00 with Blue Cross Blue Shield and Medicaid/KanCare. When comparing these rates to the Medicare benchmark of $10.32, the facility's pricing reflects a significant markup typical of commercial contracts, where rates often average 200% to 300% of the Medicare amount. If a patient receives care from an out-of-network provider or encounters unexpected ancillary services, they may face balance billing for the difference between the allowed amount and the full charge, though the No Surprises Act provides federal protections against such surprise bills for