Culture, blood
Facility: Trego County Lemke Memorial Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $51
- Cash Discount Price: $51
- vs. Medicare Baseline: 4.94x 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 494% of the Medicare baseline (a markup of 394%). 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 |
|---|---|---|
| Va Ccn - All Plans | $6 | 58% |
| Humana | $29 | 281% |
| Tricare | $32 | 310% |
| UnitedHealthcare | $37 - $60 | 359% |
| Aetna | $37 - $54 | 359% |
| Medicaid / KanCare | $37 - $60 | 359% |
| Ambetter / Centene | $41 | 397% |
| Blue Cross Blue Shield | $53 | 514% |
| Health Partners - All Plans | $57 | 552% |
| Healthy Blue Mcaid - All Plans | $60 | 581% |
Consumer Guidance & Cost Commentary
For the blood culture service (CPT 87040) at Trego County Lemke Memorial Hospital, the cash median price is $51.00, which aligns exactly with the median negotiated rate of $51.00 across all payer plans. This facility is a Critical Access Hospital in Wakeeney, Kansas, and its pricing structure reflects a government-local ownership model. While the gross charge listed is $60.00, patients with high-deductible plans or those without insurance may find the cash price advantageous, as it matches the negotiated ceiling rather than exceeding it. It is important to note that commercial rates often include administrative overheads that can inflate the baseline price by 20% to 40%, making the cash option a potentially more direct cost for self-pay patients.
The facility's pricing is consistent with the broader market, as the cash median of $51.00 matches the median negotiated amount for this service. Although the data does not provide specific state or county average figures for comparison, the facility's rate of $51.00 is comparable to the Medicare amount of $10.32 when adjusted for typical commercial markups, which often range between 200% and 300% of the Medicare rate. Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, verifying the specific status of ancillary services like laboratory tests is still recommended. To maximize savings, individuals should request a prompt-pay discount before scheduling, as paying the bill in full upfront can sometimes reduce the total cost further, though the current data shows the cash