Culture, blood
Facility: Orthopaedic Hospital of Wisconsin
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $16
- Cash Discount Price: $105
- vs. Medicare Baseline: 1.55x 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.
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 |
|---|---|---|
| Humana | $10 - $11 | 97% |
| Blue Cross Blue Shield | $15 - $25 | 145% |
| Network Health Plan | $15 | 145% |
| Children'S Community Health Plan | $18 | 174% |
| The Alliance | $18 | 174% |
Consumer Guidance & Cost Commentary
For patients paying cash directly, the most important takeaway is that this specific blood culture service has a median cash rate of $105, which is significantly lower than the facility's gross chargemaster price of $199. While commercial insurance contracts often result in higher out-of-pocket costs due to administrative overhead and network dynamics, the direct cash rate remains the baseline for self-pay comparison.
In the broader financial context, the facility's negotiated rates for this procedure range from $10 to $25 depending on the specific insurance plan, with a median negotiated rate of $16. It is worth noting that while the cash price of $105 is higher than the median negotiated rate of $16, patients with high-deductible plans or those who have not yet met their coverage thresholds may find the cash option more cost-effective if the insurer's allowed amount exceeds the cash price. Additionally, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts, as paying in full upfront can sometimes reduce the final bill further than the listed cash rate.