Culture, blood
Facility: Community Memorial Healthcare, Inc.
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $38
- Cash Discount Price: $58
- 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 |
|---|---|---|
| Aetna | $23 - $50 | 223% |
| UnitedHealthcare | $29 - $38 | 281% |
| Blue Cross Blue Shield | $38 | 368% |
Consumer Guidance & Cost Commentary
For this blood culture service at Community Memorial Healthcare, Inc. in Marysville, KS, the cash price is $58.00, which matches the facility's median negotiated rate of $38.00 and the state average of $38.00. While the facility's cash rate is higher than the county average of $23.00, it remains significantly lower than the gross chargemaster price of $58.00. For patients with high-deductible plans, paying cash directly at $58.00 could be more cost-effective than using insurance, as the insurer's allowed amount of $43.00 would likely result in a balance bill for the difference between the facility's full rate and the insurance payment.
Patients should verify their specific plan details before scheduling, as commercial negotiated rates can vary by payer; for example, Aetna plans in this facility pay up to $50.00 while UnitedHealthcare plans pay up to $38.00. To minimize costs, individuals should request a "self-pay" or "prompt-pay" discount from the billing department prior to receiving services, as paying upfront can bypass administrative fees and reduce the final amount owed. If a surprise bill arises from out-of-network ancillary services, patients are protected under the No Surprises Act and should dispute the balance billing immediately rather than accepting the charge.