Culture, blood
Facility: Minneola District Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $48
- Cash Discount Price: $37
- vs. Medicare Baseline: 4.65x 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 465% of the Medicare baseline (a markup of 365%). 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 |
|---|---|---|
| Humana | $34 - $37 | 329% |
| UnitedHealthcare | $34 - $55 | 329% |
| Va Community Care Program-All Plans | $34 - $37 | 329% |
| Blue Cross Blue Shield | $38 | 368% |
| Corporate Plan Management-All Plans | $42 - $47 | 407% |
| Providrs Care Network-All Plans | $42 - $47 | 407% |
| Preferred Health Care (Coventry)-All Other Plans | $45 - $50 | 436% |
| Triwest-All Plans | $45 - $50 | 436% |
| Phc (Coventry) Leased Network | $48 - $52 | 465% |
| Health Partners Of Kansas-All Plans | $48 - $52 | 465% |
| Aetna | $48 - $55 | 465% |
| Medicaid / KanCare | $50 - $55 | 484% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood) at Minneola District Hospital, the facility's cash median rate of $37.00 is lower than the state average of $46.00. While the hospital's negotiated rates with major payers like Humana and UnitedHealthcare range from $34 to $55, patients with high-deductible plans may find paying the cash price directly more cost-effective, as the cash rate is often below the insurer's allowed amount. Because this service is a shoppable lab test, it is crucial to verify your specific plan's deductible status before scheduling; paying the full cash price upfront can bypass administrative fees and potential deductibles, but you should explicitly request a "self-pay" or "prompt-pay" discount at registration to ensure you are receiving the lowest possible rate.
The facility's Medicare benchmark rate of $10.32 serves as the objective baseline for evaluating pricing, revealing that commercial negotiated rates typically average 200% to 300% of this federal standard. Although the hospital is a Critical Access Hospital owned by a Government Hospital District, the wide variance in negotiated rates across different payers—ranging from $34 for some plans to $55 for others—highlights the importance of comparing allowed amounts before treatment. If you receive a bill that exceeds the negotiated rate or includes unexpected charges, you should request a full itemized audit to identify errors such as code unbundling or services not rendered, as over 80% of hospital bills contain inaccuracies. Under federal protections like the No Surprises Act, you are also shielded from balance billing for out-of-network services at in-network