Culture, bacterial
Facility: Graham County Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $35
- Cash Discount Price: $46
- vs. Medicare Baseline: 4.06x 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 406% of the Medicare baseline (a markup of 306%). 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 |
|---|---|---|
| UnitedHealthcare | $4 - $47 | 46% |
| Medicaid / KanCare | $12 | 139% |
| Blue Cross Blue Shield | $32 | 371% |
| Medicare (plans) | $32 - $37 | 371% |
| Celtic Commercial-All Other Plans | $35 - $40 | 406% |
| Wppa (Providers Care)-All Plans | $40 - $47 | 464% |
Consumer Guidance & Cost Commentary
For the CPT code 87070 (Culture, bacterial) at Graham County Hospital in Hill City, KS, the cash price is $46.00, which matches the facility's median negotiated rate. This cash price is notably higher than the state average of $40.00, meaning patients paying out-of-pocket may face costs above the typical state benchmark. However, for individuals with high-deductible plans, paying the cash price of $46.00 could be more cost-effective than using insurance, as the facility's median negotiated rate of $35.00 represents the maximum amount insurance will pay, potentially leaving the patient responsible for the difference if their deductible is not yet met. Since this is a Critical Access Hospital with government-local ownership, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%.
When reviewing your bill, it is crucial to request an itemized statement rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Comparing this charge to the Medicare benchmark of $8.62 reveals that the facility's cash price is 4.1 times the Medicare rate, which aligns with the typical commercial markup range of 200% to 300% of Medicare. If you receive a large bill after using insurance, do not pay immediately; instead, dispute any balance billing by requesting a formal audit and checking your plan's allowed amount. Given that UnitedHealthcare negotiates a rate between $4 and $47 for this