Culture, blood
Facility: Salina Regional Health Center
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $133
- Cash Discount Price: $103
- vs. Medicare Baseline: 12.89x 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 1289% of the Medicare baseline (a markup of 1189%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $24 - $25 | 233% |
| Preferred Phsic | $88 | 853% |
| Preferred Healthcare - All Other Plans | $119 | 1153% |
| Multiplan (Mpi)-All Plans | $133 | 1289% |
| Aetna | $133 | 1289% |
| Providers Care (Wppa)-All Plans | $133 | 1289% |
| Cigna | $133 | 1289% |
Consumer Guidance & Cost Commentary
For this blood culture service at Salina Regional Health Center in Salina, KS, the facility's cash price of $103.00 is notably lower than the median negotiated rate of $133.00 paid by most insurers, including Blue Cross Blue Shield, Preferred Phsic, and Aetna. While the facility's cash rate is also lower than the state average for this procedure, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. To maximize savings, it is advisable to confirm with the hospital's billing department whether "self-pay" or "prompt-pay" discounts are available, which can further reduce the final amount owed.
The Medicare benchmark for this service is $10.32, which serves as a critical baseline for evaluating the facility's pricing structure. Although the commercial negotiated rates are significantly higher than the Medicare amount, this markup is standard for commercial insurance contracts that include administrative processing costs and risk premiums. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network emergency services at in-network facilities, it does not apply to routine elective procedures or non-emergency ancillary services like laboratory tests. If a patient receives a bill exceeding the allowed amount for an out-of-network service, they have the right to dispute the charge and request a review under federal surprise billing protections.