Culture, bacterial
Facility: Nmc Health
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $59
- Cash Discount Price: $63
- vs. Medicare Baseline: 6.84x 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 684% of the Medicare baseline (a markup of 584%). 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 |
|---|---|---|
| Aetna | $27 - $74 | 313% |
| Blue Cross Blue Shield | $32 | 371% |
| Wppa | $50 | 580% |
| Occunet | $54 | 626% |
| Samaritan Ministries International | $59 | 684% |
| Medincrease Health Plan | $59 | 684% |
| Prime Health Services | $68 | 789% |
| UnitedHealthcare | $81 | 940% |
| Cigna | $86 | 998% |
Consumer Guidance & Cost Commentary
For this bacterial culture service at Nmc Health in Newton, KS, the cash median price is $63.00, which is lower than the facility's gross charge of $90.00. While the facility's negotiated rates with major payers like Aetna and Blue Cross Blue Shield range from $27 to $86, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. It is important to note that while the facility is an in-network Acute Care Hospital, the No Surprises Act protects patients from balance billing for emergency care and non-emergency services from out-of-network providers at this location, though unexpected ancillary services could still trigger additional charges if not carefully reviewed.
To ensure you receive the most accurate pricing, we recommend requesting a full itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, you should inquire about prompt-pay discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims processing. When evaluating the value of this service, it is best to compare rates against the Medicare benchmark of $8.62 rather than the facility's gross list price, as commercial negotiated rates typically average 200% to 300% of the Medicare amount, while fair pricing is generally defined as 120% to 150% of that baseline.