Culture, bacterial
Facility: Mcpherson Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $158
- Cash Discount Price: $140
- vs. Medicare Baseline: 18.33x 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 1833% of the Medicare baseline (a markup of 1733%). 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 |
|---|---|---|
| Tricare | $8 | 93% |
| Humana | $9 | 104% |
| Va Ccn - All Plans | $9 | 104% |
| Wellcare Mcr Adv - All Plans | $9 | 104% |
| Healthy Blue Mcr Adv | $9 | 104% |
| Blue Cross Blue Shield | $9 | 104% |
| UnitedHealthcare | $9 - $204 | 104% |
| Ambetter / Centene | $10 | 116% |
| Wppa - All Plans | $122 - $143 | 1415% |
| Central Plains - All Plans | $131 - $153 | 1520% |
| Medical Associates - All Plans | $131 - $153 | 1520% |
| Christian Health Aid - All Plans | $140 - $163 | 1624% |
| Aetna | $144 - $204 | 1671% |
| Multiplan - All Plans | $158 - $184 | 1833% |
| Health Partners - All Plans | $166 - $194 | 1926% |
| First Health - All Plans | $166 - $194 | 1926% |
| Cigna | $166 - $194 | 1926% |
| Medicaid / KanCare | $175 - $204 | 2030% |
| Health Blue Mcaid - All Other Plans | $178 - $208 | 2065% |
Consumer Guidance & Cost Commentary
For the bacterial culture service (CPT 87070) at McPherson Hospital in McPherson, Kansas, the facility's cash price of $140.00 is notably lower than the state average of $153.00. While most major payers, including Tricare, Humana, and Blue Cross Blue Shield, negotiate rates that align closely with or slightly exceed the cash price, UnitedHealthcare and Aetna have negotiated ranges that can reach up to $204.00. This disparity highlights that for patients with high-deductible plans, paying the cash price upfront may be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash rate. Patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill by bypassing administrative claim processing fees.
The facility's negotiated rates generally reflect the administrative costs associated with insurance billing, which can inflate the final amount compared to direct cash payment. For instance, while the median negotiated rate across payers is $158.00, the Medicare benchmark for this service is only $8.62, indicating that commercial rates are significantly marked up above the federal baseline. It is important to note that the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, but patients should still verify their specific plan details to ensure they are not facing unexpected charges. By comparing the facility's rates against the state average and understanding the difference between cash and negotiated pricing, consumers can make informed decisions about whether to use insurance or pay directly.