CMS Price Transparency Data

Culture, bacterial

Facility: Palos Community Hospital

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $142
Cash Discount Price: $126
vs. Medicare Baseline: 16.47x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at Palos Community Hospital is $142. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $126. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 16.47x the Medicare baseline. Located in 12251 South 80Th Avenue, Palos Heights, IL.

Cash / Self-Pay

$126

Average discount available for prompt cash payment at this facility.

Insurance Median

$142

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: $126 (1462%)

Insurance Median: $142 (1647%)

Cash: $126 (1462% of Medicare)

Ins. Median: $142 (1647% 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 1647% of the Medicare baseline (a markup of 1547%). 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
Blue Cross Blue Shield	$25 - $259	290%
Aetna	$33 - $259	383%
Carelon Behavioral Health [159]	$77 - $130	893%
Healthlink [125]	$77 - $259	893%
Magellan Behavioral Hlth [136]	$92 - $155	1067%
Multiplan/Phcs [142]	$108 - $259	1253%
Compsych [112]	$116 - $194	1346%
First Health Plan [6034]	$116 - $194	1346%
Beechstreet [176]	$123 - $207	1427%
Cigna	$123 - $259	1427%
Health'S Finest Network [126]	$131 - $220	1520%
Galaxy Health Network [220]	$154 - $259	1787%
Global Excel [1712]	$154 - $259	1787%
Health Alliance [181]	$154 - $259	1787%
UnitedHealthcare	$154 - $259	1787%

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 $126.
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 Palos Community Hospital 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.