Culture, blood
Facility: Smith County Memorial Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $59
- Cash Discount Price: $99
- vs. Medicare Baseline: 5.72x 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 572% of the Medicare baseline (a markup of 472%). 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 | 368% |
| Medicaid / KanCare | $41 - $140 | 397% |
| Multiplan-All Plans | $53 - $126 | 514% |
| Wppa-All Plans | $55 - $132 | 533% |
| Health Partners Of Ks Ppo-All Plans | $56 - $133 | 543% |
| UnitedHealthcare | $56 - $133 | 543% |
| Midlands Choice-All Plans | $56 - $133 | 543% |
Consumer Guidance & Cost Commentary
For this blood culture service at Smith County Memorial Hospital in Smith Center, Kansas, the cash price is $99.00, which matches the facility's median negotiated rate. This cash price is significantly lower than the state average for this procedure, making it a strong option for patients with high-deductible plans or those without insurance. While the facility's negotiated rates for Medicaid and other payers range from $56.00 to $140.00, the cash price remains the most predictable cost for patients who can pay upfront. To secure the lowest possible rate, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these programs often offer additional reductions beyond the standard cash price.
It is important to understand that commercial insurance rates are often higher than cash prices due to administrative costs and contract structures, even though they appear to be discounted from the hospital's full list price. In this case, the Medicare benchmark of $10.32 serves as a baseline, showing that the cash price of $99.00 represents a substantial markup over federal reimbursement rates. Patients should avoid accepting summary bills that obscure individual charges and instead request a detailed, itemized statement to ensure no errors exist. If a patient receives a bill exceeding the negotiated rate, they may be facing balance billing, which is generally prohibited for emergency care and non-emergency services at in-network facilities under federal law. Disputing any unexpected charges in writing is the most effective way to protect against surprise costs.