Culture, bacterial
Facility: Ellsworth County Medical Center
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $42
- Cash Discount Price: $56
- vs. Medicare Baseline: 4.87x 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 487% of the Medicare baseline (a markup of 387%). 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 |
|---|---|---|
| Triwest -All Plans | $19 - $65 | 220% |
| Healthy Blue Mcr Adv | $19 - $65 | 220% |
| Va Ccn-All Plans | $19 - $65 | 220% |
| Humana | $19 - $130 | 220% |
| UnitedHealthcare | $26 - $137 | 302% |
| Blue Cross Blue Shield | $30 - $32 | 348% |
| First Health - All Plans | $36 - $124 | 418% |
| Aetna | $36 - $124 | 418% |
| Cigna | $38 - $130 | 441% |
| Medicaid / KanCare | $40 - $137 | 464% |
| Healthy Blue Mcaid- All Other Plans | $40 - $137 | 464% |
| Coventry Mcaid-All Plans | $40 - $137 | 464% |
| Providers Care-Wppa-All Plans | $59 - $206 | 684% |
Consumer Guidance & Cost Commentary
For the CPT code 87070 (Culture, bacterial) at Ellsworth County Medical Center, the cash price is $56.00, which matches the facility's cash median. This rate is significantly lower than the state average for this service, where commercial negotiated rates typically range from $30 to $130 depending on the insurer. While the facility's cash price is competitive, patients with high-deductible plans may find it beneficial to pay the cash price directly, as the negotiated rates for in-network payers like UnitedHealthcare and Humana can exceed $100. To maximize savings, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final amount owed by 20% to 50% if settled upfront.
When reviewing your bill, it is crucial to request a full 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 your facility's rates to the Medicare benchmark of $8.62 reveals that the cash price of $56.00 represents a markup of approximately 4.9 times the Medicare rate, which is consistent with commercial pricing structures. If you receive a large bill after insurance processing, you should verify whether the facility submitted a claim to your insurer, as automatic claims submission can void any cash discount agreements. Always dispute any errors in writing to the billing supervisor to ensure accurate reimbursement and avoid unnecessary debt.