Culture, bacterial
Facility: Grisell Memorial Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $42
- Cash Discount Price: $68
- vs. Medicare Baseline: 4.87x 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 487% of the Medicare baseline (a markup of 387%). 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 |
|---|---|---|
| UnitedHealthcare | $6 - $54 | 70% |
| Blue Cross Blue Shield | $30 | 348% |
| Medicaid / KanCare | $72 | 835% |
| Humana | $72 | 835% |
Consumer Guidance & Cost Commentary
For the bacterial culture service (CPT 87070) at Grisell Memorial Hospital in Ransom, Kansas, the facility's cash median rate of $68.00 is notably higher than the state average of $42.00. While Medicaid and Humana pay the full gross amount of $72.00, UnitedHealthcare and Blue Cross Blue Shield negotiate rates ranging from $6 to $72 depending on the specific plan, with a median negotiated payment of $63.00. Because the cash price exceeds the median negotiated payment, patients with high-deductible plans might find it more cost-effective to pay the cash rate directly, provided they secure a prompt-pay discount. It is crucial to ask the hospital for self-pay or prompt-pay discounts before scheduling, as these upfront payment incentives can significantly reduce the final bill by bypassing administrative claim processing fees.
This service is benchmarked against Medicare, which sets a fixed reimbursement rate of $8.62 for this procedure. The facility's gross charge of $72.00 represents a substantial markup compared to the Medicare baseline, illustrating how commercial rates often exceed the true cost of care. Although the facility is a Critical Access Hospital owned by a Government Hospital District, the lack of a published facility rating means consumer verification remains essential. To avoid unexpected costs, patients should request an itemized billing audit to ensure no unbundled codes or services not rendered are included in the final invoice. Given that over 80% of hospital bills contain errors, obtaining a detailed line-by-line statement before payment is the most effective way to identify discrepancies and negotiate a fair price.