Culture, blood
Facility: St Luke Hospital & Living Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $53
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 5.14x 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 514% of the Medicare baseline (a markup of 414%). 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 |
|---|---|---|
| Kansas Department Of Health And Environment | $53 | 514% |
| UnitedHealthcare | $53 | 514% |
| Blue Cross Blue Shield | $53 | 514% |
| Humana | $53 | 514% |
| Va Ccn | $53 | 514% |
| Bluestem Pace | $53 | 514% |
| Ambetter / Centene | $54 | 523% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood) at St Luke Hospital & Living Center in Marion, KS, the facility's negotiated rates range from $53 to $54, which aligns closely with the state average of $53. This facility is a Critical Access Hospital owned by a Government Hospital District, and its pricing structure reflects the typical administrative overhead associated with commercial insurance contracts. While the gross charge listed is $104, commercial payers such as UnitedHealthcare, Blue Cross Blue Shield, and Humana have agreed to pay significantly less under their contracts. It is important to note that these negotiated rates often exceed the actual cash price for patients paying out-of-pocket, meaning individuals with high-deductible plans might save money by paying cash directly if the facility offers a self-pay discount.
To minimize costs, patients should verify if the hospital offers a prompt-pay discount, which can reduce bills by 20% to 50% for upfront payment and bypasses the administrative costs of claims processing. Additionally, since the facility is in-network, the No Surprises Act generally protects patients from balance billing for out-of-network services at this location, though it is still advisable to request an itemized billing audit to ensure no unbundled codes or services not rendered are included. When evaluating the value of this service, comparing the facility's allowed amount to the Medicare rate of $10.32 reveals a significant markup, highlighting that commercial rates often exceed the federal benchmark by a wide margin. Consumers are encouraged to contact the billing department directly to confirm their specific plan's allowed amount and any available cash-pay incentives before scheduling the test.