Culture, blood
Facility: Girard Medical Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $77
- Cash Discount Price: $132
- vs. Medicare Baseline: 7.46x 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 746% of the Medicare baseline (a markup of 646%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $38 - $77 | 368% |
| Humana | $77 | 746% |
| Medicare (plans) | $77 | 746% |
| Kansas Superior Select-All Plans | $77 | 746% |
| Aetna | $77 - $385 | 746% |
| Ambetter / Centene | $77 | 746% |
| UnitedHealthcare | $77 - $209 | 746% |
| Multiplan-All Plans | $204 | 1977% |
| Uhhis-All Plans | $209 | 2025% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood) at Girard Medical Center in Girard, KS, the facility's cash median price is $132.00, which is lower than the state average of $185.00. While the facility is a Critical Access Hospital owned by a Government Hospital District, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead. For instance, Aetna's negotiated range spans from $77 to $385, and UnitedHealthcare's range is $77 to $209, meaning a patient with a high-deductible plan might save money by paying the cash price of $132.00 directly rather than relying on insurance, provided they have not yet met their deductible.
The facility's Medicare benchmark rate is $10.32, which serves as the objective baseline for evaluating pricing markup. Commercial negotiated rates at this location average significantly higher than this federal standard, with the lowest negotiated rate being $77.00 and the highest reaching $385.00. To ensure you are receiving fair pricing, it is recommended to request an itemized billing audit before paying, as summary bills can obscure errors or unbundled charges. Additionally, patients should inquire about prompt-pay discounts, which can reduce the final balance by 20% to 50% if paid upfront, effectively bypassing the costly claims processing cycle that inflates insurance rates.