Culture, bacterial
Facility: Hamilton County Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $54
- Cash Discount Price: $59
- vs. Medicare Baseline: 6.26x 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 626% of the Medicare baseline (a markup of 526%). 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 - $32 | 174% |
| First Health Coventry - All Plans | $46 - $54 | 534% |
| Cigna | $51 - $61 | 592% |
| UnitedHealthcare | $51 - $61 | 592% |
| Va Ccn - All Plans | $54 - $64 | 626% |
| Aetna | $91 - $109 | 1056% |
Consumer Guidance & Cost Commentary
For this bacterial culture service at Hamilton County Hospital in Syracuse, KS, the cash price is $59.00, which matches the facility's median paid amount. This cash rate is significantly lower than the negotiated rates charged to insurance payers, who typically pay between $46.00 and $109.00 depending on their specific plan. While the facility is a Critical Access Hospital with government local ownership, patients with high-deductible plans or those without insurance may find the cash price more affordable than their insurance allowed amounts. It is important to note that commercial payers like Aetna and Va Ccn - All Plans have negotiated rates that exceed the cash price, meaning paying out-of-pocket upfront could result in immediate savings compared to having insurance process the claim.
To maximize potential savings, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling or checking in, as these upfront fee reductions can lower the final bill by 20% to 50%. Additionally, since the facility is in-network for most major carriers, the No Surprises Act generally protects patients from unexpected balance billing for emergency care or non-emergency services from out-of-network providers at this location. However, if a patient receives care from an out-of-network provider or encounters services that were not covered by their plan, they should request a full itemized billing audit to identify any errors or unbundled charges before making a payment.