Culture, blood
Facility: Osborne County Memorial Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $101
- Cash Discount Price: $95
- vs. Medicare Baseline: 9.79x 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 979% of the Medicare baseline (a markup of 879%). 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 |
|---|---|---|
| UnitedHealthcare | $85 | 824% |
| Health Partners Of Kansas | $96 | 930% |
| Wppa | $106 | 1027% |
| Blue Cross Blue Shield | $110 | 1066% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood) at Osborne County Memorial Hospital in Osborne, KS, the facility's cash median price is $95.00, which is lower than the gross charge of $112.00. While the hospital is a Critical Access Hospital with government-local ownership, the negotiated rates for in-network payers range from $85.00 to $110.00, with UnitedHealthcare and Health Partners Of Kansas offering the lowest contracted amounts at $85.00 and $96.00, respectively. It is important to note that for patients with high-deductible plans, paying the cash price of $95.00 upfront can sometimes be more cost-effective than using insurance, as the negotiated rates for some carriers exceed the cash price. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed.
When evaluating the cost against federal benchmarks, the Medicare amount for this service is $10.32. The facility's cash price of $95.00 represents a significant markup relative to the Medicare rate, illustrating how commercial rates often differ substantially from the government's cost-based baseline. While the data does not provide specific state or county average comparisons for this exact code, understanding that commercial negotiated rates typically average between 200% and 300% of Medicare helps contextualize the pricing structure. To ensure you are receiving the most accurate billing information, we recommend requesting an itemized bill to verify all charges and checking your specific plan's deductible status before scheduling, as paying out-of-pocket may result in lower