Culture, bacterial
Facility: Ashland Health Center
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $62
- Cash Discount Price: $50
- vs. Medicare Baseline: 7.19x 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 719% of the Medicare baseline (a markup of 619%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $15 - $34 | 174% |
| Compalliance-All Plans | $36 - $82 | 418% |
| Health Partners Of Kansas-All Plans | $38 - $87 | 441% |
| Multiplan-All Plans | $44 - $100 | 510% |
| Aetna | $45 - $102 | 522% |
| Medicare (plans) | $45 - $102 | 522% |
| Health Choice-All Plans | $45 - $102 | 522% |
| UnitedHealthcare | $45 - $102 | 522% |
| Medica Mcare - All Plans | $45 - $102 | 522% |
| Medicaid / KanCare | $45 - $102 | 522% |
| Healthy Blue Mcr Adv - All Other Plans | $45 - $102 | 522% |
| Providers Care (Wppa)-All Plans | $67 - $153 | 777% |
Consumer Guidance & Cost Commentary
For the CPT code 87070 (Culture, bacterial) at Ashland Health Center in Ashland, KS, the facility's cash median price is $50.00, which is lower than the state average of $53.00. While the facility's median negotiated rate is $62.00, this amount is significantly higher than the cash price, illustrating that commercial insurance contracts often include administrative overhead that can exceed the direct cost of care. For patients with high-deductible plans, paying the $50.00 cash rate may be more financially advantageous than relying on insurance, as the negotiated rate of $62.00 could result in higher out-of-pocket costs if the patient has not yet met their deductible. It is important to note that the facility's gross charge is $62.00, and patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling to potentially lower this amount further.
When evaluating the cost of this service, it is critical to compare rates against the Medicare benchmark rather than the facility's gross charges, as Medicare rates represent a scientifically validated baseline for the true cost of delivery. The Medicare amount for this procedure is $8.62, and the facility's cash rate is approximately 5.8 times higher than this benchmark, which is consistent with the typical commercial markup range of 200% to 300% seen in many markets. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though unexpected charges can still occur if ancillary services like lab tests are billed out-of-network. To