Culture, blood
Facility: Wilson Medical Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $61
- Cash Discount Price: $57
- vs. Medicare Baseline: 5.91x 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 591% of the Medicare baseline (a markup of 491%). 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 - $76 | 368% |
| Tricare | $40 | 388% |
| Humana | $40 | 388% |
| Aetna | $40 - $76 | 388% |
| Ambetter / Centene | $40 - $76 | 388% |
| UnitedHealthcare | $40 - $71 | 388% |
| Cigna | $61 | 591% |
| Health Partners-All Plans | $70 | 678% |
| Mulitplan-All Plans | $70 | 678% |
Consumer Guidance & Cost Commentary
For this blood culture service at Wilson Medical Center in Neodesha, KS, the cash median price is $57.00, which is lower than the facility's negotiated rates of $61.00 and the gross charge of $76.00. While the facility is a Critical Access Hospital with government ownership, patients should be aware that insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. If you have a high-deductible plan, paying the cash price of $57.00 upfront might result in lower out-of-pocket costs compared to your insurance paying its negotiated rate of $61.00 and leaving you responsible for your deductible or coinsurance. Additionally, many facilities offer prompt-pay discounts for self-pay patients, so it is advisable to ask the billing department about potential fee reductions before scheduling your visit.
The data indicates that the facility's cash rate is significantly lower than the median paid amount of $40.00 across various payers, suggesting that commercial insurance contracts may not always reflect the lowest possible price for this service. While the facility is located in a Critical Access Hospital network, the specific pricing for this CPT code varies by insurer, with allowed amounts ranging from $38.00 to $76.00 depending on the plan. To avoid unexpected balance billing, patients should verify their specific plan's allowed amount and ensure they understand their coverage status before receiving care. If you receive a bill that exceeds the cash price or your expected insurance payment, you have the right to request an itemized audit to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain discrepancies that can be