Culture, bacterial
Facility: Ellinwood District Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $61
- Cash Discount Price: $74
- vs. Medicare Baseline: 7.08x 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 708% of the Medicare baseline (a markup of 608%). 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 |
|---|---|---|
| Aetna | $41 - $86 | 476% |
| Cigna | $41 - $86 | 476% |
| UnitedHealthcare | $41 - $86 | 476% |
| Blue Cross Blue Shield | $41 - $86 | 476% |
| Humana | $41 - $86 | 476% |
Consumer Guidance & Cost Commentary
For this bacterial culture service at Ellinwood District Hospital, the cash price of $74.00 is notably lower than the median negotiated rate of $61.00 paid by major insurers like Aetna, Cigna, and UnitedHealthcare. This price difference highlights a common billing dynamic where commercial insurance contracts often result in higher out-of-pocket costs for patients compared to self-pay options, particularly for those with high-deductible plans. While the facility's cash rate is significantly below the gross chargemaster of $87.00, patients should verify if their specific insurance plan has a deductible that would require them to pay the full negotiated amount before any coverage applies. Additionally, because this facility is a Critical Access Hospital in Kansas, patients should proactively ask about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill if settled in full upfront.
When evaluating the cost of this service, it is important to compare rates against the federal Medicare benchmark rather than the hospital's inflated list price. The Medicare amount for this procedure is $8.62, and the facility's cash rate of $74.00 represents a significant markup above this baseline, which is typical for commercial pricing structures. However, the median amount paid by insurers ($41.00) is only slightly higher than the Medicare rate, suggesting that the negotiated contracts in this region are relatively tight compared to the gross charges. To avoid unexpected costs, patients should request a detailed, itemized bill to ensure no unbundled charges or services not rendered are included, as summary bills often obscure individual line items. If a balance bill arises from an out-of-network ancillary service, patients should not pay