Culture, blood
Facility: Oakleaf Surgical Hospital
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $10
- Cash Discount Price: $62
- vs. Medicare Baseline: 0.97x 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 |
|---|---|---|
| Blue Cross Blue Shield | $10 | 97% |
| Dean Health Plan | $10 | 97% |
| Group Health Cooperative Of Eau Claire | $10 | 97% |
| Healthpartners | $10 | 97% |
| Humana | $10 | 97% |
| Medica | $10 | 97% |
| Quartz Health Solutions | $10 | 97% |
| Security Health Plan Of Wi | $10 | 97% |
| Ucare Wi | $10 | 97% |
| UnitedHealthcare | $10 | 97% |
Consumer Guidance & Cost Commentary
For this culture and sensitivity test at Oakleaf Surgical Hospital in Altoona, WI, the cash price of $62 is notably lower than the facility's gross charge of $69 and significantly below the state average of $62. While the Medicare benchmark of $10.32 represents the baseline cost for this procedure, the cash rate offered to self-pay patients is more than five times higher than the Medicare amount, yet remains the most affordable option compared to the facility's list price. The data indicates a single payer count of 10, with all listed commercial plans negotiating a rate of $10, which is substantially lower than the gross charge but still higher than the cash price.
Patients should be aware that while the negotiated rate of $10 is the standard for in-network coverage, paying directly can sometimes be more economical if the patient's insurance deductible has not been met or if the plan's allowed amount exceeds the cash price. It is crucial to confirm with the facility whether "self-pay" or "prompt-pay" discounts are available, as these upfront payment options can reduce the final bill further. Since the cash rate of $62 is already below the gross charge, verifying the exact status of any potential discounts before scheduling ensures the patient receives the lowest possible cost for this blood culture service.