Culture, blood
Facility: Amberwell Atchison Association
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $53
- Cash Discount Price: $103
- vs. Medicare Baseline: 5.14x 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 514% of the Medicare baseline (a markup of 414%). 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 | $34 - $185 | 329% |
| Superior Select Mcr Adv - All Plans | $34 | 329% |
| Humana | $34 - $46 | 329% |
| Va Ccn - All Plans | $34 | 329% |
| Triwest - All Plans | $34 | 329% |
| Blue Cross Blue Shield | $36 - $38 | 349% |
| Ambetter / Centene | $53 | 514% |
| Cigna | $57 | 552% |
| Aetna | $57 | 552% |
| Centrus Health Direct - All Plans | $77 | 746% |
| Oscar - All Plans | $77 | 746% |
| Multiplan - All Plans | $80 | 775% |
| Wppa Providrs Care - All Plans | $93 | 901% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood), the facility's cash price is $103.00, which matches the cash median for this procedure in Atchison, KS. While the facility's negotiated rates range from $34 to $93 depending on the insurance plan, these amounts are significantly higher than the Medicare benchmark of $10.32. Under Medicare benchmarking principles, commercial rates often average 200% to 300% of the Medicare rate, whereas fair pricing is typically defined as 120% to 150%. In this case, the lowest negotiated rate of $34 exceeds the Medicare benchmark by approximately 230%, indicating a substantial markup relative to the federal cost baseline.
Patients should be aware that paying cash upfront may result in a lower total cost than using insurance, as the facility's cash price of $103.00 is comparable to the median negotiated rate of $53.00 paid by many commercial payers, yet the administrative overhead of insurance claims can inflate the baseline price by 20% to 40%. To minimize out-of-pocket expenses, patients are encouraged to ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid in full before or shortly after the service. Additionally, since the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients should verify their network status and request an itemized bill to ensure no unexpected charges are included.