CMS Price Transparency Data

Culture, bacterial

Facility: HSHS St Elizabeth's Hospital

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 87070
  • Insurance Median: $18
  • Cash Discount Price: $59
  • vs. Medicare Baseline: 2.09x Medicare
The contracted insurance negotiated median rate for a Culture, bacterial at HSHS St Elizabeth's Hospital is $18. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 2.09x the Medicare baseline. Located in One St Elizabeth Boulevard, O Fallon, IL.
Cash / Self-Pay
$59

Average discount available for prompt cash payment at this facility.

Insurance Median
$18

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: $59 (684%)
Insurance Median: $18 (209%)
Cash: $59 (684% of Medicare)
Ins. Median: $18 (209% 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 209% of the Medicare baseline (a markup of 109%). 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.

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
Amish Community $5 - $41 58%
Meridian Health Plan $8 93%
Molina Healthcare $8 - $9 93%
Aetna $9 - $102 104%
Blue Cross Blue Shield $9 - $145 104%
Clear Spring Health Of Illinois $9 104%
Health Alliance Medical Plans $9 - $123 104%
Health Partners $9 104%
Humana $9 104%
Sae Hospice $9 104%
UnitedHealthcare $9 - $145 104%
Wellfirst $12 - $93 139%
First Health $13 - $108 151%
Caterpillar, Inc. $14 - $116 162%
Cigna $14 - $145 162%
Healthlink $14 - $145 162%
Choicecare $16 - $130 186%
Consociate Group $16 - $128 186%
Healthcare Finest Network (Hfn) $16 - $130 186%
Multiplan/Phcs $16 - $130 186%
Provider Network Of America $16 - $130 186%
Celtic Insurance Company $18 209%
City Of Springfield $18 - $145 209%
Claim Doc $18 - $22 209%
Current Health Solutions $18 - $145 209%
Healthscope $18 - $145 209%
Hopetrust $18 - $22 209%
Illinois Breast And Cervical Cancer Program $18 - $145 209%
Interplan $18 - $145 209%
Live360 $18 - $145 209%
Wexford $18 - $145 209%
Naphcare $19 220%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: One St Elizabeth Boulevard, O Fallon, IL 62269
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals