Culture, bacterial
Facility: Lmh
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $9
- Cash Discount Price: $60
- vs. Medicare Baseline: 1.04x 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.
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 |
|---|---|---|
| UnitedHealthcare | $7 - $46 | 81% |
| Blue Cross Blue Shield | $7 - $156 | 81% |
| Allwell | $9 | 104% |
| Haskell Indian Health Services | $9 | 104% |
| Humana | $9 | 104% |
| Aetna | $9 - $200 | 104% |
| Cigna | $9 - $161 | 104% |
| Medicare (plans) | $9 | 104% |
| Ambetter / Centene | $13 | 151% |
| Non Contracted | $193 | 2239% |
| First Health | $225 | 2610% |
Consumer Guidance & Cost Commentary
For the CPT code 87070 (Culture, bacterial), the facility in Lawrence, KS, lists a gross charge of $242.00, with a cash median price of $60.00. This cash rate is significantly lower than the facility's negotiated rates, which range from $7 to $225 depending on the insurance carrier. For patients with high-deductible plans, paying the $60.00 cash price may be more cost-effective than relying on insurance, as commercial negotiated rates often include administrative overhead that inflates the baseline price. It is important to note that while the facility is an in-network Acute Care Hospital owned by the Government - Local, the specific negotiated amount varies widely; for instance, Aetna plans may see rates up to $200, whereas non-contracted services are billed at $193.
When evaluating the cost against federal benchmarks, the Medicare amount for this service is $8.62, which serves as a baseline for the true cost of delivery. The facility's cash rate of $60.00 represents a markup relative to this Medicare rate, but it remains substantially lower than the gross charges. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under federal law, though unexpected charges can still occur if ancillary services are out-of-network. To minimize costs, consumers are encouraged to request a self-pay or prompt-pay discount before scheduling, as paying the bill upfront can often bypass the administrative fees associated with insurance claims processing. Always verify the specific allowed amount with the hospital prior to receiving care to avoid surprises.