Culture, bacterial
Facility: Providence Medical Center
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $9
- Cash Discount Price: $8
- 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 |
|---|---|---|
| Medicaid / KanCare | $7 | 81% |
| UnitedHealthcare | $7 - $14 | 81% |
| Celtic | $8 - $14 | 93% |
| Healthy Blue | $8 - $9 | 93% |
| Cigna | $9 | 104% |
| Kansas Superior Select | $9 | 104% |
| Medicare (plans) | $9 | 104% |
| Midland Care Connection | $9 | 104% |
| Tricare | $9 | 104% |
| Blue Cross Blue Shield | $9 - $21 | 104% |
| Aetna | $9 - $15 | 104% |
| Corizon | $11 | 128% |
| Employer Direct Healthcare | $12 | 139% |
| Well Path Prison | $12 | 139% |
| Naphcare | $13 | 151% |
| Centurion | $13 | 151% |
| Comp Alliance - Fka Compresults Worker Compensation | $18 | 209% |
| Worker Compensation | $19 | 220% |
| Oha Networks | $19 | 220% |
Consumer Guidance & Cost Commentary
For the bacterial culture service (CPT 87070) at Providence Medical Center in Kansas City, KS, the facility's cash median rate of $8.00 is significantly lower than the state average of $117.00, which represents the median amount paid by insurance plans. While commercial insurance contracts often result in higher negotiated rates due to administrative costs and claim processing fees, patients with high-deductible plans may find paying the cash price directly more cost-effective if their insurance allowed amount exceeds the cash rate. It is important to note that while the facility offers prompt-pay discounts for upfront payment, these rates are distinct from the cash median and should be verified directly with the hospital before scheduling to ensure the best financial outcome.
The Medicare benchmark for this service is $8.62, which serves as a scientifically validated baseline for the true cost of care, whereas the facility's gross charge of $157.00 reflects the full chargemaster list price. Comparing the cash rate to the Medicare benchmark reveals that the facility's cash price is slightly lower than the federal standard, suggesting a competitive pricing structure for self-pay patients. However, patients should be aware that balance billing can occur if they receive care from out-of-network providers or ancillary services without proper notification, potentially leading to unexpected bills for the difference between the allowed amount and the full charge. To avoid these pitfalls, consumers are encouraged to request an itemized billing audit before finalizing payment to identify any errors, unbundled codes, or services not rendered, ensuring they are only paying for what was actually provided.