Culture, blood
Facility: Sheridan County Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $199
- Cash Discount Price: $329
- vs. Medicare Baseline: 19.28x 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 1928% of the Medicare baseline (a markup of 1828%). 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 | $53 | 514% |
| Celtic Insurance | $199 | 1928% |
| UnitedHealthcare | $313 | 3033% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood) at Sheridan County Hospital in Hoxie, KS, the cash price is $329.00, which matches the facility's median negotiated rate of $199.00 for Celtic Insurance and the gross charge. This cash price is significantly higher than the Medicare benchmark of $10.32, reflecting a markup of 19.3% above the federal baseline. While commercial payers like Blue Cross Blue Shield and UnitedHealthcare have negotiated rates of $53 and $313 respectively, patients with high-deductible plans may find the cash price more affordable if their insurance allowed amount exceeds $329.00. It is important to note that the cash rate represents the self-pay price; patients should always ask the hospital directly about "prompt-pay" discounts or self-pay classifications before scheduling to potentially lower the final cost.
This service is provided by a Critical Access Hospital with local government ownership, and the billing data reflects a single plan for each of the three major payers listed. Because hospitals often issue summary bills that obscure individual line items, patients should request a full itemized CPT-coded statement to verify that no unbundled charges or services not rendered are included. If a balance bill arises from out-of-network ancillary services, the No Surprises Act may protect the patient from paying the difference between the chargemaster and the insurance allowed amount. To ensure fair pricing, consumers should compare the facility's rates against the Medicare benchmark rather than the inflated gross charges, as the latter can make discounts appear larger than they actually are.