Culture, bacterial
Facility: Pratt Regional Medical Center
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $61
- Cash Discount Price: $47
- vs. Medicare Baseline: 7.08x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 708% of the Medicare baseline (a markup of 608%). 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Christian Health Aid | $28 - $134 | 325% |
| UnitedHealthcare | $31 - $183 | 360% |
| Health Partners Of Kansas | $31 - $152 | 360% |
| Aetna | $33 - $161 | 383% |
| Choicecare | $37 - $179 | 429% |
Consumer Guidance & Cost Commentary
For the bacterial culture service (CPT 87070) at Pratt Regional Medical Center in Pratt, KS, the facility's cash median rate of $47.00 is notably lower than the state average, which sits at $68.00. While commercial insurance plans like UnitedHealthcare and Aetna negotiate rates ranging from $31 to $183, these figures often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash rate directly, as the $47.00 self-pay amount is significantly lower than the negotiated amounts typically required by insurers. It is important to note that the facility's cash median is also higher than the Medicare benchmark of $8.62, illustrating that commercial rates generally include a markup over the federal government's fixed reimbursement baseline.
To ensure you receive the most accurate pricing, we recommend contacting the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill. Although the facility is in-network for five major payers, patients should verify their specific deductible status before scheduling, as many commercial plans will only cover the negotiated rate once the deductible is met. Additionally, while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is prudent to request an itemized billing audit if you receive a summary bill, as over 80% of hospital invoices contain errors such as unbundled codes or charges for services not rendered. Always confirm that your payment is classified as self-pay to avoid automatic claims submission, which could void any potential cash discounts.