Culture, bacterial
Facility: Nemaha Valley Community Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $43
- Cash Discount Price: $75
- vs. Medicare Baseline: 4.99x 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 499% of the Medicare baseline (a markup of 399%). 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 |
|---|---|---|
| Va Ccn - All Plans | $7 | 81% |
| Aetna | $37 - $71 | 429% |
| Humana | $37 | 429% |
| Celtic Comm Exch - All Plans | $40 | 464% |
| Partners Direct Health - All Plans | $43 | 499% |
| Multiplan - All Plans | $75 | 870% |
| Health Partners - All Plans | $79 | 916% |
| Midlands Choice - All Plans | $79 | 916% |
Consumer Guidance & Cost Commentary
For the bacterial culture service (CPT 87070) at Nemaha Valley Community Hospital in Seneca, KS, the cash median price is $75.00, which is $5.00 higher than the state average. While commercial insurance plans like Aetna and Humana negotiate rates ranging from $37 to $71, these negotiated amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. The facility, a voluntary non-profit Critical Access Hospital, offers a median negotiated rate of $43.00, which is significantly lower than the gross charge of $83.00, but patients should verify their specific plan's allowed amount before scheduling to ensure they are not subject to balance billing.
To minimize unexpected costs, patients should explicitly ask for "self-pay" or "prompt-pay" discounts before check-in, as these upfront payments can bypass administrative fees and reduce the final bill. If a patient receives an itemized bill, they should request a full line-by-line audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected. It is also important to compare the facility's rates against the Medicare benchmark of $8.62; while commercial rates are naturally higher due to administrative overhead, understanding this baseline helps patients evaluate whether the negotiated or cash price is fair relative to the true cost of care.