Culture, blood
Facility: Bob Wilson Memorial Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $137
- Cash Discount Price: $67
- vs. Medicare Baseline: 13.28x 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 1328% of the Medicare baseline (a markup of 1228%). 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 |
|---|---|---|
| Centura Employee Plan | $13 | 126% |
| Blue Cross Blue Shield | $51 | 494% |
| Medicare (plans) | $54 | 523% |
| Aetna | $54 - $134 | 523% |
| UnitedHealthcare | $54 - $140 | 523% |
| Kansas Health | $54 | 523% |
| Humana | $54 | 523% |
| Multiplan | $151 - $156 | 1463% |
| Health Partners Of Kansas | $158 | 1531% |
| Wppa | $160 | 1550% |
Consumer Guidance & Cost Commentary
For this blood culture service at Bob Wilson Memorial Hospital in Ulysses, Kansas, the facility's cash price of $67.00 is significantly lower than the median negotiated rates paid by insurance plans, which range from $51 to $160 depending on the carrier. While the facility is a Critical Access Hospital owned by a voluntary non-profit church, patients should be aware that insurance contracts often result in higher out-of-pocket costs than paying cash directly. For individuals with high-deductible plans, paying the cash price of $67.00 upfront may be more cost-effective than relying on insurance, which could result in a negotiated rate exceeding $100 after deductibles are met. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these programs can further reduce the final amount owed.
The facility's pricing also compares favorably against federal benchmarks; the Medicare amount for this code is $10.32, and the cash rate of $67.00 represents a reasonable markup compared to the national average where commercial rates often reach 200% to 300% of Medicare. However, patients should exercise caution regarding balance billing, which can occur if a patient receives care from out-of-network providers or ancillary services like emergency physicians, potentially leading to bills for the difference between the provider's full charge and the insurance allowed amount. To avoid unexpected costs, consumers should request a detailed, itemized bill before paying and dispute any errors formally in writing, as over 80% of hospital bills contain mistakes such as double-billing or unbundled codes that can be corrected through a systematic audit.