Culture, blood
Facility: Lincoln County Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $38
- Cash Discount Price: $128
- vs. Medicare Baseline: 3.68x 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 368% of the Medicare baseline (a markup of 268%). 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 | 368% |
Consumer Guidance & Cost Commentary
For this blood culture service at Lincoln County Hospital in Lincoln, KS, the cash price of $128.00 is significantly lower than the facility's negotiated rate of $38.00, which represents the maximum amount Blue Cross Blue Shield will pay. This facility is a Critical Access Hospital with government-local ownership, and while the cash price is competitive, patients should verify their specific plan's deductible status before relying on insurance, as high deductibles can lead to out-of-pocket costs exceeding the cash rate. Additionally, the facility's negotiated rate is 3.7 times higher than the Medicare benchmark of $10.32, highlighting that commercial contracts often include administrative overhead that inflates the baseline price beyond the true cost of care.
To minimize costs, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid upfront, bypassing the administrative fees associated with insurance claims. It is also important to request a full itemized bill before paying, as summary invoices may hide unbundled codes or services not rendered, and disputes should be handled in writing to ensure corrections are made. While this specific data point does not provide a direct comparison to state or county averages, understanding that the facility's rates are benchmarked against Medicare helps clarify that the $128.00 cash price is a substantial discount from the standard chargemaster, making it a potentially more affordable option for those without insurance or with high-deductible plans.