Culture, blood
Facility: Morris County Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $89
- Cash Discount Price: $136
- vs. Medicare Baseline: 8.62x 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 862% of the Medicare baseline (a markup of 762%). 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 |
|---|---|---|
| Providrs Care (Wppa)(Nexus)-All Plans | $10 | 97% |
| Aetna | $18 | 174% |
| Va Ccn-All Plans | $23 | 223% |
| Blue Cross Blue Shield | $36 - $89 | 349% |
| UnitedHealthcare | $89 - $227 | 862% |
| Coventry Mcr | $89 | 862% |
| Choice Care Mcr Adv-All Plans | $89 | 862% |
| Cigna | $164 | 1589% |
| Multiplan-All Plans | $204 | 1977% |
| Coventry Comm-All Other Plans | $204 | 1977% |
Consumer Guidance & Cost Commentary
For the CPT code 87040, representing a blood culture at Morris County Hospital in Council Grove, KS, the cash median price is $136.00, which is significantly higher than the state average of $10.32. While the facility's negotiated rates range from $10 to $227 depending on the payer, patients with high-deductible plans may find paying cash directly more cost-effective, as the cash price is lower than many commercial negotiated rates. To secure the best possible price, it is recommended to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% when paid upfront, bypassing the administrative costs associated with insurance claims processing.
When evaluating the cost relative to Medicare, the facility's cash rate of $136.00 is 8.6 times the Medicare benchmark of $10.32, highlighting a substantial markup common in commercial pricing structures. Although the median negotiated amount across payers is $89.00, this figure does not guarantee the lowest possible charge for every patient, as some commercial rates exceed the cash price. Consumers should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, it is crucial to verify the specific allowed amount with the insurance carrier before scheduling to avoid unexpected costs, and to request a detailed itemized bill to ensure all charges are accurate and bundled correctly.