Culture, bacterial
Facility: Rooks County Health Center
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $90
- Cash Discount Price: $75
- vs. Medicare Baseline: 10.44x 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 1044% of the Medicare baseline (a markup of 944%). 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 | $32 | 371% |
| Celtic Mcr Adv | $47 | 545% |
| Tricare | $47 | 545% |
| Veterans Admin - All Plans | $47 | 545% |
| Celtic Comm - All Other Plans | $51 | 592% |
| Aetna | $90 | 1044% |
| Preferred Benefits Admin | $90 | 1044% |
| UnitedHealthcare | $90 | 1044% |
| Preferred Hlthcare - All Other Plans | $95 | 1102% |
| Health Partners - All Plans | $95 | 1102% |
| Healthy Blue Mcaid - All Plans | $100 | 1160% |
Consumer Guidance & Cost Commentary
For the CPT code 87070 (Culture, bacterial) at Rooks County Health Center in Plainville, KS, the facility's cash median rate of $75.00 is lower than the state average of $90.00, making it a potentially cost-effective option for self-pay patients. While the facility's negotiated rates with insurance payers, such as Blue Cross Blue Shield and Aetna, average $90.00, these amounts are higher than the cash price due to administrative overhead and contract structures. For patients with high-deductible plans, paying the cash rate of $75.00 upfront could result in significant savings compared to the $90.00 allowed amount, provided the patient has not yet met their deductible. It is important to note that while the facility is a Critical Access Hospital owned by a Government Hospital District, the cash price remains the most transparent baseline for comparison against the broader market.
When evaluating the cost of this service, it is crucial to compare rates against the Medicare benchmark of $8.62, which serves as the scientifically validated cost baseline for healthcare delivery. Although the facility's cash rate of $75.00 is significantly higher than the Medicare amount, this reflects the actual cost of provider services including physician work and practice expenses, rather than a markup on a federal rate. Patients should be aware that commercial negotiated rates often average 200% to 300% of Medicare, whereas fair pricing is typically defined as 120% to 150%. To maximize savings, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce