Culture, blood
Facility: Memorial Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $81
- Cash Discount Price: $147
- vs. Medicare Baseline: 7.85x 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 785% of the Medicare baseline (a markup of 685%). 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 | $27 | 262% |
| Tricare | $74 | 717% |
| Humana | $74 | 717% |
| Medicare (plans) | $74 | 717% |
| Ambetter / Centene | $81 | 785% |
| Coventry - All Other Plans | $133 | 1289% |
| Preferred Healthcare-All Plans | $140 | 1357% |
| Health Partners Of Kansas - All Plans | $140 | 1357% |
| Wppa/Providers Care-All Plans | $206 | 1996% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood) at Memorial Hospital in Abilene, KS, the cash price is $147.00, which matches the facility's median paid amount. This cash rate is significantly higher than the state average of $10.32, representing a markup of 7.8 times the Medicare benchmark. While commercial insurance plans like Blue Cross Blue Shield, Tricare, and Humana negotiate a rate of $74.00, this amount is still above the Medicare baseline. Patients with high-deductible plans may find the cash price of $147.00 more affordable than the negotiated rate if their insurance deductible has not yet been met, as the insurer would otherwise pay the higher contracted amount before covering the patient's responsibility.
To minimize unexpected costs, patients should verify whether the facility offers "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payments can reduce the final bill. It is also important to request a full itemized billing audit rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Under federal protections like the No Surprises Act, patients are generally shielded from balance billing for out-of-network services at in-network facilities, but they should still dispute any surprise charges in writing to ensure their rights are upheld.