Culture, bacterial

For the CPT code 87070 (Culture, bacterial) at Mercy Hospital Pittsburg, Inc, the facility's cash median price of $111.00 is significantly lower than the state average of $130.00 for negotiated rates. While many commercial payers, including UnitedHealthcare and Aetna, have negotiated rates ranging from $8 to $152, the cash price offers a potential savings for patients with high-deductible plans who may not yet have met their out-of-pocket maximum. It is important to note that while the facility is a voluntary non-profit church-owned acute care hospital, patients should verify their specific plan's allowed amount before scheduling, as some in-network contracts can exceed the cash price. Additionally, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can further reduce the final cost if the bill is settled in full upfront.

The data indicates that Medicare reimbursement for this service is $8.62, serving as a baseline for evaluating the facility's pricing structure. The facility's cash rate of $111.00 represents a markup of 15.1% over the Medicare amount, which aligns with fair pricing benchmarks typically defined between 120% and 150% of Medicare rates. Commercial negotiated rates vary widely, with some contracts reaching up to $152, whereas the cash option remains the most transparent and potentially lowest-cost option at $111.00. Consumers should be aware that balance billing is generally prohibited for emergency services under the No Surprises Act, but it is crucial to request an itemized bill to ensure no unbundled charges