CMS Price Transparency Data

Culture, bacterial

Facility: Decatur Memorial Hospital

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $89
Cash Discount Price: $212
vs. Medicare Baseline: 10.32x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at Decatur Memorial Hospital is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $212. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 10.32x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$212

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $212 (2459%)

Insurance Median: $89 (1032%)

Cash: $212 (2459% of Medicare)

Ins. Median: $89 (1032% 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 1032% of the Medicare baseline (a markup of 932%). 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
Aetna	$8 - $202	93%
Blue Cross Blue Shield	$8 - $301	93%
Coventry	$8 - $153	93%
Health Alliance	$8 - $200	93%
Humana	$8 - $196	93%
Medicare (plans)	$8	93%
UnitedHealthcare	$8 - $301	93%
Veterans Administration	$8	93%
Wellcare	$8	93%
Tricare	$9	104%
Caterpillar	$11	128%
Medicaid / KanCare	$11	128%
Plain Church Medical Group	$12 - $135	139%
Mennonite Churches	$43 - $105	499%
Illinois Workers Compensation	$48 - $98	557%
Health Alliance Mh Employee Plan	$56 - $138	650%
Cigna	$57 - $140	661%
6 Degrees Health	$73 - $181	847%
Hopetrust	$73 - $181	847%
Hst	$73 - $181	847%
Phcs Savility	$79 - $196	916%
Phcs Multiplan Ppo	$83 - $205	963%
Healthlink	$84 - $206	974%
Corvel	$88 - $217	1021%
Consociate	$90 - $223	1044%
Hfn	$92 - $226	1067%
Commercial Workers Compensation	$93	1079%
Liability	$122 - $301	1415%

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 $212.
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 Decatur Memorial 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.