Culture, blood
Facility: Clay County Medical Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $38
- Cash Discount Price: $41
- 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $37 - $39 | 359% |
| Aetna | $37 - $39 | 359% |
| UnitedHealthcare | $38 - $40 | 368% |
| Health Partners - All Plans | $38 - $40 | 368% |
| Multiplan- All Plans | $38 - $40 | 368% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood) at Clay County Medical Center in Clay Center, KS, the cash median price is $41.00, which matches the facility's gross charge. This rate is notably higher than the state average of $38.00, though it aligns closely with the county average. While commercial insurance plans like Aetna, UnitedHealthcare, and Wppa/Providrs Care have negotiated rates ranging from $37 to $40, these amounts are often higher than the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find paying the $41.00 cash rate directly more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if the deductible has not yet been met.
To ensure you are receiving the best possible rate, it is important to understand that hospitals frequently offer prompt-pay discounts for self-pay patients who settle their bill upfront, potentially reducing the $41.00 charge. Additionally, if you have been billed by an out-of-network provider at this facility, the No Surprises Act protects you from balance billing for emergency care and non-emergency services at in-network hospitals. If you receive a bill that seems excessive, you should request a full itemized audit to verify that all charges are accurate and that no services were unbundled or incorrectly coded before making any payment.