Culture, bacterial
Facility: Menorah Medical Center
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $76
- Cash Discount Price: $969
- vs. Medicare Baseline: 8.82x 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 882% of the Medicare baseline (a markup of 782%). 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 |
|---|---|---|
| Cigna | $4 - $784 | 46% |
| Amerigroup | $7 | 81% |
| United | $7 - $441 | 81% |
| Aetna | $8 - $500 | 93% |
| Healthyblue | $8 | 93% |
| Medicaid / KanCare | $8 | 93% |
| Home State Health Plan | $8 | 93% |
| Unicare | $8 | 93% |
| Blue Cross Blue Shield | $9 - $441 | 104% |
| Devoted Health | $9 | 104% |
| Wellcare | $9 | 104% |
| Celtic | $9 | 104% |
| Humana | $9 - $21 | 104% |
| Coventry | $9 - $394 | 104% |
| Pyramid Life | $9 | 104% |
| Triwest Health Alliance | $9 | 104% |
| Oscar | $13 | 151% |
| Multiplan | $16 - $725 | 186% |
| Corvel Corporation | $18 - $637 | 209% |
| Oha Network | $19 - $490 | 220% |
| Ambetter / Centene | $31 - $182 | 360% |
| Nhc Advantage | $32 - $186 | 371% |
| Wppa Providrs Care Network | $34 - $196 | 394% |
| Universal Healthcare | $59 - $343 | 684% |
| Coventry Kc Mo | $69 - $402 | 800% |
| College Park Family Care Center | $73 - $421 | 847% |
| Cco, Inc. | $127 - $735 | 1473% |
| Focus Healthcare Mgmt, Inc | $127 - $735 | 1473% |
Consumer Guidance & Cost Commentary
For the bacterial culture service (CPT 87070) at Menorah Medical Center in Overland Park, KS, the cash price is $969.00, which matches the facility's median paid amount. This cash rate is significantly higher than the state average of $8.62 for Medicare, representing an 8.8% increase over the federal benchmark. While commercial insurance plans like Cigna, Amerigroup, and United offer negotiated rates ranging from $4 to $784, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket directly. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still verify their specific plan details and ask the hospital about self-pay or prompt-pay discounts before scheduling to ensure they are not charged the full chargemaster rate.
The facility's negotiated rates vary widely across payers, with the lowest allowed amount being $4 for Cigna and the highest reaching $784 for Multiplan. Because commercial rates are often inflated by administrative costs and contract structures, the cash price of $969.00 may actually be the most cost-effective option for individuals who have not met their deductible or possess high-deductible plans. Patients should request an itemized bill to review specific CPT codes and avoid paying for services that were not rendered or were incorrectly bundled. If a balance bill is received, consumers should dispute it in writing with the insurer rather than paying immediately, as federal protections may apply depending on the nature of the care and the provider's network status.