Culture, blood
Facility: Hiawatha Community Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $80
- Cash Discount Price: $103
- vs. Medicare Baseline: 7.75x 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 775% of the Medicare baseline (a markup of 675%). 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 | $36 - $38 | 349% |
| Humana | $38 | 368% |
| Aetna | $38 - $83 | 368% |
| UnitedHealthcare | $38 - $88 | 368% |
| Ambetter / Centene | $46 | 446% |
| Centrus Health Direct - All Plans | $77 | 746% |
| Oscar - All Plans | $77 | 746% |
| Preferred Hlth - All Plans | $93 | 901% |
| Wppa Providrs Care - All Plans | $98 | 950% |
| Cigna | $98 | 950% |
| Multiplan - All Plans | $100 | 969% |
| Midlands Choice - All Plans | $100 | 969% |
| Healthy Blue Mcaid - All Plans | $103 | 998% |
Consumer Guidance & Cost Commentary
For the blood culture service (CPT 87040) at Hiawatha Community Hospital, the cash price is $103.00, which matches the facility's gross charge and the Medicare benchmark of $10.32. While the hospital is a Critical Access Hospital in Hiawatha, KS, the negotiated rates vary significantly by insurer, ranging from a low of $36 with Blue Cross Blue Shield to a high of $103 with Healthy Blue MCAid. It is important to note that for patients with high-deductible plans, paying the cash price of $103.00 upfront can sometimes be more cost-effective than relying on insurance, as the negotiated rates paid by commercial payers often exceed the cash price due to administrative overhead and contract structures. Additionally, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full before or shortly after the service.
When comparing pricing against benchmarks, the facility's cash rate of $103.00 is 7.8% higher than the Medicare amount, reflecting the standard markup for commercial services. The median negotiated rate across all payers is $80.00, which is lower than the cash price, suggesting that for those with active insurance coverage, the in-network allowed amount may result in lower out-of-pocket costs depending on their deductible status. However, patients must be aware that assuming in-network status guarantees the lowest price is a common pitfall, as different insurers negotiate different ceilings. To ensure transparency, consumers should request an itemized bill to review specific CPT codes and