CMS Price Transparency Data
Culture, bacterial
Facility: Saint Joseph Regional Medical Center - Plymouth
Billing Code: 87070 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 87070
- Insurance Median: $38
- Cash Discount Price: $138
- vs. Medicare Baseline: 4.41x Medicare
The contracted insurance negotiated median rate for a Culture, bacterial at Saint Joseph Regional Medical Center - Plymouth is $38. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $138. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 4.41x the Medicare baseline. Located in 1915 Lake Ave, Plymouth, IN.
Cash / Self-Pay
$138
Average discount available for prompt cash payment at this facility.
Insurance Median
$38
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: $138 (1601%)
Insurance Median: $38 (441%)
Cash: $138 (1601% of Medicare)
Ins. Median: $38 (441% 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 441% of the Medicare baseline (a markup of 341%). 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.
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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 | $5 - $160 | 58% |
| Blue Cross Blue Shield | $5 - $17 | 58% |
| Medicaid / KanCare | $5 - $9 | 58% |
| UnitedHealthcare | $5 - $208 | 58% |
| Plain Church Group | $8 - $88 | 93% |
| County Coroner | $9 | 104% |
| Managed Health Services - Indiana | $9 | 104% |
| Mdwise | $9 | 104% |
| Medicare (plans) | $9 | 104% |
| Meridian Complete | $9 | 104% |
| Pace-Trinity Health | $9 | 104% |
| Provider Partners Health Plan Of Indiana | $9 | 104% |
| Auxiant | $13 - $271 | 151% |
| Caresource | $13 | 151% |
| Physicians Health Plan Northern Indiana Health Insurance | $13 - $26 | 151% |
| St Joseph County Hlth Dpt | $13 | 151% |
| Asr Health Benefits | $14 - $160 | 162% |
| Christian Brother Services | $14 - $160 | 162% |
| Employee Benefit Management | $14 - $160 | 162% |
| Medical Mutual | $14 - $160 | 162% |
| Meritain | $14 - $160 | 162% |
| Preferred One | $14 - $160 | 162% |
| Rural Carrier Health Benefit Plan | $14 - $160 | 162% |
| Siho Insurance Services | $14 | 162% |
| Webtpa | $14 - $160 | 162% |
| Allied Benefit Systems | $16 - $213 | 186% |
| Key Benefit Administrator | $16 - $229 | 186% |
| Notre Dame Athletic Association | $16 - $180 | 186% |
| Wc Notre Dame | $16 - $180 | 186% |
| Ameriben | $17 - $196 | 197% |
| Blue Benefit Administrators Of Massachusetts | $17 | 197% |
| Blue Care Network | $17 | 197% |
| Blue Distinction Transplant | $17 | 197% |
| Blue Shield - Ca | $17 | 197% |
| Blue Shield - Id (Regence) | $17 | 197% |
| Blue Shield - Ny Highmark Northeastern | $17 | 197% |
| Blue Shield - Ny Highmark Western | $17 | 197% |
| Blue Shield - Pa (Highmark) | $17 | 197% |
| Blue Shield - Wa (Regence) | $17 | 197% |
| Luminare Health (Detroit) | $17 - $196 | 197% |
| Geha | $18 - $208 | 209% |
| Healthscope | $18 - $208 | 209% |
| Student Insurance Cma | $18 - $208 | 209% |
| Custom Design Benefits | $19 | 220% |
| Encore Health | $20 - $229 | 232% |
| Indiana Criminal Justice Inst | $20 - $229 | 232% |
| Western & Southern Financial Group | $20 - $229 | 232% |
| Cigna | $21 - $235 | 244% |
| Group Administrators | $21 - $235 | 244% |
| Health Partners | $21 - $235 | 244% |
| Mvp | $21 - $235 | 244% |
| Prairie States | $21 - $235 | 244% |
| Priority Health | $21 - $235 | 244% |
| Professional Benefit Administrators | $21 - $235 | 244% |
| Sagamore Health Network | $21 - $252 | 244% |
| Sisco Benefits | $21 - $235 | 244% |
| Unified Group Services | $21 - $235 | 244% |
| Goshen Preferred Network | $22 - $281 | 255% |
| Signature Care | $24 - $271 | 278% |
| Allied National Global Care | $26 - $294 | 302% |
| Asrm - Reliance Standard Life Insurance | $26 - $294 | 302% |
| Avmed Health Plan | $26 - $294 | 302% |
| Christian Care Ministry | $26 - $294 | 302% |
| Dean Health | $26 - $294 | 302% |
| Fallon Health | $26 - $294 | 302% |
| Family Life Insurance Company | $26 - $294 | 302% |
| Freedom Life Insurance Company | $26 - $294 | 302% |
| Ghc Scw | $26 - $294 | 302% |
| International Benefit Administrators | $26 - $294 | 302% |
| Lifetime Benefit Solutions | $26 - $294 | 302% |
| Manhattan Life | $26 - $294 | 302% |
| Medi Share | $26 - $294 | 302% |
| Multiplan | $26 - $294 | 302% |
| Pai | $26 - $294 | 302% |
| Pan-American Life | $26 - $294 | 302% |
| Paramount Hmo | $26 - $294 | 302% |
| Phcs | $26 - $294 | 302% |
| Philadelphia American Life Insurance | $26 - $294 | 302% |
| Trinity Health Share | $26 - $294 | 302% |
| Bankers Life Casualty | $29 - $327 | 336% |
| Bureau Of Disability | $29 - $327 | 336% |
| Wc Align Network | $29 - $327 | 336% |