Culture, bacterial
Facility: Holton Community Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $47
- Cash Discount Price: $56
- vs. Medicare Baseline: 5.45x 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 545% of the Medicare baseline (a markup of 445%). 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 |
|---|---|---|
| Humana | $25 - $41 | 290% |
| Kansas Superior Select - All Plans | $25 - $42 | 290% |
| Aetna | $25 - $78 | 290% |
| UnitedHealthcare | $25 - $78 | 290% |
| Blue Cross Blue Shield | $32 | 371% |
| Preferred Health Professionals | $39 - $64 | 452% |
| Preferred Health Freedom | $39 - $64 | 452% |
| Preferred Health Fn Select - All Other Plans | $39 - $64 | 452% |
| Wppa Providers - All Plans | $45 - $74 | 522% |
| Medicaid / KanCare | $47 - $78 | 545% |
Consumer Guidance & Cost Commentary
For the CPT code 87070 (Culture, bacterial) at Holton Community Hospital in Holton, KS, the cash median price is $56.00, while the facility's negotiated rates with insurance payers range from $25.00 to $78.00 depending on the plan. It is important to note that cash-pay can sometimes be more cost-effective for patients with high-deductible plans if the insurance negotiated rate exceeds the cash price, as the administrative overhead of processing claims often inflates the final bill. Before scheduling, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can offer a fee reduction of 20% to 50% for upfront payment, bypassing the costly claims processing cycle that insurance billing requires.
When evaluating the cost against federal benchmarks, the Medicare amount for this service is $8.62, which serves as the objective baseline for fair pricing. While commercial negotiated rates often average 200% to 300% of Medicare, fair pricing is typically defined as 120% to 150% of the Medicare rate. For this specific procedure, the median negotiated rate of $47.00 is lower than the gross charge of $74.00 but still represents a significant markup over the Medicare benchmark. Patients should avoid relying on summary bills and instead request a detailed, itemized statement to ensure no errors or unbundled charges are included, as over 80% of hospital bills contain discrepancies that can be resolved through a formal written audit.