Culture, blood
Facility: William Newton Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $37
- Cash Discount Price: $103
- vs. Medicare Baseline: 3.59x 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 359% of the Medicare baseline (a markup of 259%). 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 | $11 - $93 | 107% |
| Triwest- All Plans | $36 | 349% |
| Blue Cross Blue Shield | $36 - $37 | 349% |
| Ambetter / Centene | $37 - $103 | 359% |
| Providrs Care Nexus | $63 | 610% |
| Providrs Care - All Other Plans | $72 | 698% |
Consumer Guidance & Cost Commentary
For the CPT code 87040 (Culture, blood) at William Newton Hospital in Winfield, KS, the cash price is $103.00, which matches the facility's gross charge and the state average. While the hospital's negotiated rates for in-network plans range from $36 to $103, the median negotiated amount is $37.00. This suggests that for patients with high-deductible plans, paying the cash price of $103.00 directly may be more cost-effective than relying on insurance, as the insurer's allowed amount often exceeds the cash rate. Patients should verify their specific plan's deductible status and ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can significantly reduce the final bill.
It is important to note that Medicare rates for this service are set at $10.32, which serves as a benchmark for fair pricing rather than a target for commercial billing. Commercial negotiated rates often exceed Medicare benchmarks due to administrative costs and contract structures, but the data shows a median negotiated rate of $37.00, which is approximately 3.6 times the Medicare amount. To avoid unexpected costs, patients should request a full itemized bill that lists specific CPT codes rather than accepting summary invoices, as these can hide unbundled charges or services not rendered. If a balance bill arises from an out-of-network ancillary service, patients should dispute the amount with their insurer under the No Surprises Act rather than paying immediately to protect their credit and financial rights.