Culture, blood
Facility: Fredonia Regional Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $60
- Cash Discount Price: $78
- vs. Medicare Baseline: 5.81x 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 581% of the Medicare baseline (a markup of 481%). 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 | $7 - $80 | 68% |
| Blue Cross Blue Shield | $33 - $44 | 320% |
| Aetna | $34 - $80 | 329% |
| Veterans Programs - All Plans | $34 - $45 | 329% |
| Cigna | $60 - $80 | 581% |
| Meritain-All Plans | $60 - $80 | 581% |
| Reserve National-All Plans | $60 - $80 | 581% |
Consumer Guidance & Cost Commentary
For the CPT code 87040, representing a blood culture at Fredonia Regional Hospital in Kansas, the cash price is $78.00, which matches the facility's median negotiated rate. This cash price is significantly lower than the typical commercial negotiated rates seen across payers like UnitedHealthcare and Aetna, where allowed amounts range from $33 to $80. When comparing this facility's pricing to the national baseline, the cash rate is 5.8% higher than the Medicare benchmark of $10.32. While Medicare rates serve as the objective cost baseline for evaluating hospital pricing markups, patients with high-deductible plans may find that paying the cash price of $78.00 upfront is more cost-effective than relying on insurance, which often results in higher negotiated rates due to administrative overhead and contract dynamics.
Patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing costly insurance claims processing. It is important to note that while the facility is a Critical Access Hospital owned by the local government, the negotiated rates for commercial payers can vary widely; for instance, Veterans Programs and Cigna have negotiated rates at the $60.00 median, whereas UnitedHealthcare plans can see rates as high as $80.00. To ensure you are receiving the best possible price, always request an itemized bill and confirm whether your specific plan has met its deductible before assuming the insurance negotiated rate will be the lowest option available.