Culture, blood
Facility: Mitchell County Hospital Health Systems
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $172
- Cash Discount Price: $163
- vs. Medicare Baseline: 16.67x 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 1667% of the Medicare baseline (a markup of 1567%). 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 | $10 - $181 | 97% |
| Blue Cross Blue Shield | $38 | 368% |
| Triwest Well Mark All Plans | $154 | 1492% |
| Pref Hlth Care Sytms Comm - All Plans | $163 | 1579% |
| Aetna | $163 | 1579% |
| First Health-All Plans | $163 | 1579% |
| Multiplan Ppo - All Plans | $172 | 1667% |
| Auxiant-All Plans | $172 | 1667% |
| Phc Leased Ntwrk Access - All Plans | $172 | 1667% |
| Health Partners Ks-All Plans | $179 | 1734% |
| Cigna | $179 | 1734% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood) at Mitchell County Hospital Health Systems in Beloit, KS, the cash price is $163.00, which aligns closely with the facility's median negotiated rate of $172.00. While the gross chargemaster lists up to $181.00, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rates from major payers like UnitedHealthcare and Aetna often exceed the cash amount. It is important to note that this facility, a Critical Access Hospital with government-local ownership, offers a cash median of $163.00, which is significantly lower than the gross charge but comparable to the state average for this service.
The Medicare benchmark for this procedure is $10.32, highlighting that commercial rates are substantially higher than the federal baseline. Although the facility's cash rate is lower than the gross charge, patients should be aware that balance billing can still occur if they receive out-of-network ancillary services, such as emergency lab work, even at an in-network hospital. To avoid unexpected costs, consumers should request an itemized bill to verify all charges and ask specifically about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final amount owed.