Culture, blood
Facility: Children'S Mercy South
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $81
- Cash Discount Price: $60
- 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 |
|---|---|---|
| UnitedHealthcare | $9 - $84 | 87% |
| Medicaid / KanCare | $11 | 107% |
| Healthy Blue | $11 - $28 | 107% |
| Home State Health | $25 | 242% |
| Blue Cross Blue Shield | $51 - $92 | 494% |
| Cigna | $60 - $87 | 581% |
| Medica | $73 | 707% |
| Aetna | $75 - $85 | 727% |
| Wppa Providrs Care | $81 | 785% |
| Health Midwest Comprehensive Care | $81 | 785% |
| Wellfit/Centrus | $81 | 785% |
| Nebraska Furniture Mart | $81 | 785% |
| Orscheln | $81 | 785% |
| Centivo | $81 | 785% |
| Quiktrip | $81 | 785% |
| Humana | $83 | 804% |
| Coxhealth Network | $92 | 891% |
| Coventry Health Care Of Kansas | $92 | 891% |
| Mercy Health | $94 | 911% |
| Multiplan | $95 | 921% |
| American Healthcare Alliance | $106 | 1027% |
| Healthlink | $110 | 1066% |
| National Preferred Provider Network | $112 | 1085% |
Consumer Guidance & Cost Commentary
For the CPT code 87040, representing a blood culture, Children's Mercy South in Overland Park, KS, has a cash median price of $60.00, which is significantly lower than the facility's negotiated rates. While the facility's negotiated average is $81.00, commercial payers such as UnitedHealthcare and Healthy Blue have negotiated rates ranging from $9 to $92, with many plans settling at $81.00. This cash price of $60.00 is notably lower than the state average for this service, making it an attractive option for patients with high-deductible plans or those seeking to minimize out-of-pocket costs. If your insurance plan has a high deductible, paying the cash price directly may result in lower total costs compared to your insurer's negotiated rate, which often includes administrative overhead and contract markups.
To ensure you are receiving the most favorable rate, it is recommended to request a prompt-pay discount before scheduling your visit, as facilities often offer reductions of 20% to 50% for upfront payments. Additionally, patients should avoid accepting summary bills and instead demand a full itemized statement to verify that no unbundled charges or services not rendered are included in the final invoice. While Medicare sets a benchmark of $10.32 for this procedure, commercial rates vary widely; for instance, UnitedHealthcare plans may pay as low as $9, while others like American Healthcare Alliance pay $106. By comparing these specific negotiated amounts against your plan's coverage and asking about self-pay discounts, you can avoid unexpected billing surprises and ensure transparency in your healthcare spending.