CMS Price Transparency Data

Culture, bacterial

Facility: Iowa Specialty Hospital - Clarion

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $17
Cash Discount Price: $12
vs. Medicare Baseline: 1.97x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at Iowa Specialty Hospital - Clarion is $17. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $12. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 1.97x the Medicare baseline. Located in 1316 South Main Street, Clarion, IA.

Cash / Self-Pay

$12

Average discount available for prompt cash payment at this facility.

Insurance Median

$17

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$8.62

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $8.62 (100%)

Cash / Self-Pay: $12 (139%)

Insurance Median: $17 (197%)

Cash: $12 (139% of Medicare)

Ins. Median: $17 (197% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $8.62 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Tricare	$6 - $42	70%
Triwest Va - All Plans	$6 - $42	70%
Healthscope Stellar-All Plans	$10 - $71	116%
Auxiant Clarion Schools-All Plans	$12 - $87	139%
Health Partners Ish-All Other Plans	$14 - $107	162%
Health Partners Prestage	$14 - $100	162%
Aetna	$15 - $114	174%
Cigna	$17 - $130	197%
Midlands Choice-All Plans	$17 - $130	197%
UnitedHealthcare	$17 - $127	197%
Wellmark Hmo	$36	418%
Wellmark Ppo - All Other Plans	$39	452%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $12.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 87070.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Iowa Specialty Hospital - Clarion is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 87070.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.