Culture, blood
Facility: Republic County Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $66
- Cash Discount Price: $54
- vs. Medicare Baseline: 6.40x 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 640% of the Medicare baseline (a markup of 540%). 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 |
|---|---|---|
| Rural Carriers-All Plans | $61 | 591% |
| Aetna | $65 | 630% |
| Meritain-All Plans | $65 | 630% |
| UnitedHealthcare | $66 | 640% |
| First Health-All Plans | $68 | 659% |
| Cigna | $68 | 659% |
| Midlands Choice-All Plans | $68 | 659% |
Consumer Guidance & Cost Commentary
For this blood culture service at Republic County Hospital in Belleville, KS, the negotiated rates for major payers range from $61 to $68, which is notably higher than the facility's cash price of $54.00. While commercial insurance contracts often include administrative overhead that inflates these rates, patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the $54.00 amount is significantly lower than the insurer's allowed amounts. To maximize savings, it is recommended to verify your specific plan's deductible status before scheduling and to explicitly request a "self-pay" or "prompt-pay" discount from the billing department, which can reduce the final cost further.
The facility's pricing is also evaluated against federal benchmarks, showing a 6.4% markup over the Medicare rate of $10.32 for this procedure. Although the hospital is a Critical Access Hospital with a voluntary non-profit ownership structure, the negotiated rates for in-network carriers remain above the cash median. Consumers should be aware that assuming an in-network rate is the lowest possible price is a common pitfall, as different insurers have distinct contract terms. If you receive a bill, always demand a full itemized statement to ensure no errors exist, and remember that the No Surprises Act protects you from balance billing for out-of-network services at this in-network facility.