Culture, blood
Facility: Phillips County Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $48
- Cash Discount Price: $45
- vs. Medicare Baseline: 4.65x 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 465% of the Medicare baseline (a markup of 365%). 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 - $43 | 368% |
| UnitedHealthcare | $42 - $53 | 407% |
| Health Partners-All Plans | $53 | 514% |
| Medicaid / KanCare | $53 | 514% |
Consumer Guidance & Cost Commentary
For the "Culture, blood" procedure at Phillips County Hospital, the cash price of $45.00 is lower than the facility's negotiated rates with major payers like Blue Cross Blue Shield ($38–$43) and UnitedHealthcare ($42–$53). This aligns with the broader trend where cash payments can sometimes be more cost-effective for patients with high-deductible plans, as the insurance negotiated rate often exceeds the cash price. While the facility is a Critical Access Hospital in Phillipsburg, KS, and is government-owned, patients should verify if their specific plan covers this service and whether the cash price applies to their situation. It is important to note that while the facility offers a cash median of $45.00, the actual amount paid by insurance members may vary based on their individual plan's deductible and copay structures.
Patients should be aware that commercial insurance rates are often inflated by administrative costs and contract dynamics, with negotiated rates frequently sitting between 200% and 300% of the Medicare benchmark of $10.32 for this service. To ensure you are not overpaying, always request a prompt-pay discount if you choose to pay out-of-pocket, which can reduce the bill by 20% to 50% and bypass costly insurance billing cycles. If you receive a bill from an out-of-network provider or unexpected ancillary services at this in-network facility, you may be protected under the No Surprises Act, which bans balance billing for emergency and non-emergency care. Always demand a full itemized bill before paying to identify any errors, double-billing, or unbundled codes, as over 80% of