CMS Price Transparency Data

Culture, bacterial

Facility: Knoxville Hospital & Clinics

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $62
Cash Discount Price: $69
vs. Medicare Baseline: 7.19x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at Knoxville Hospital & Clinics is $62. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $69. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 7.19x the Medicare baseline. Located in 1002 South Lincoln Street, Knoxville, IA.

Cash / Self-Pay

$69

Average discount available for prompt cash payment at this facility.

Insurance Median

$62

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: $69 (800%)

Insurance Median: $62 (719%)

Cash: $69 (800% of Medicare)

Ins. Median: $62 (719% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 719% of the Medicare baseline (a markup of 619%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Wellmark Hmo 7/1/22	$33	383%
Wellmark Ppo 7/1/22-All Other Plans	$36	418%
Molina Mcaid/Chip - All Plans	$42 - $56	487%
Amerigroup Mcaid	$43 - $57	499%
Iowa Total Care Mcaid - All Plans	$43 - $57	499%
Aetna	$44 - $58	510%
Amerigroup Mcr - All Other Plans	$44 - $59	510%
Humana	$44 - $112	510%
UnitedHealthcare	$44 - $122	510%
Oscar-All Plans	$65 - $87	754%
Health Partners New Bus	$69 - $92	800%
Medical Associates Health Plan-All Other Plans	$74 - $99	858%
Cigna	$96 - $128	1114%
Health Partners-All Other Plans	$96 - $128	1114%
Medica Op And Profee Only-All Plans	$96 - $128	1114%
Midlands Choice-All Plans	$96 - $128	1114%

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 $69.
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 Knoxville Hospital & Clinics 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.