Culture, bacterial
Facility: Kansas Heart Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $9
- Cash Discount Price: $20
- 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 |
|---|---|---|
| Aetna | $3 - $5 | 35% |
| Tricare | $8 | 93% |
| Celtic Mcr Adv | $9 | 104% |
| Medicaid / KanCare | $9 | 104% |
| Humana | $9 | 104% |
| UnitedHealthcare | $9 | 104% |
| Wppa - All Plans | $12 - $21 | 139% |
| Blue Cross Blue Shield | $21 | 244% |
| Multiplan - All Plans | $27 - $47 | 313% |
Consumer Guidance & Cost Commentary
For this bacterial culture service at Kansas Heart Hospital in Wichita, the cash median price is $20.00, which is lower than the facility's negotiated rates of $9.00 and the median paid amount of $24.00. This pricing structure highlights a common billing dynamic where paying out-of-pocket can sometimes be more cost-effective than using insurance, particularly for patients with high deductibles or those whose insurance negotiated rates exceed the cash price. While the facility's facility rating is 4 out of 5, patients should be aware that commercial rates often include administrative overhead that can inflate the baseline price by 20% to 40% compared to the true cost of care.
To ensure you are not overcharged, it is crucial to request a full itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. If you receive a surprise bill from an out-of-network provider, you may be entitled to protections under the No Surprises Act, which bans balance billing for emergency care and non-emergency services at in-network facilities. Additionally, since the cash median of $20.00 is significantly lower than the gross charge of $32.00, you should contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can further reduce your final obligation by bypassing costly insurance claims processing.