Culture, bacterial
Facility: Clara Barton Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $74
- Cash Discount Price: $63
- vs. Medicare Baseline: 8.58x 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 858% of the Medicare baseline (a markup of 758%). 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 | $32 | 371% |
| 6 Degrees Health - All Plans | $38 - $71 | 441% |
| Wppa-All Plans | $43 - $82 | 499% |
| UnitedHealthcare | $49 - $92 | 568% |
| Phcs - All Plans | $49 - $92 | 568% |
| Aetna | $49 - $92 | 568% |
| Hlth Partners Of Ks-All Plans | $50 - $94 | 580% |
Consumer Guidance & Cost Commentary
For the CPT code 87070 (Culture, bacterial) at Clara Barton Hospital in Hoisington, KS, the cash median price is $63.00, which is lower than the facility's negotiated rates of $72.00 to $74.00. This pricing structure suggests that patients with high-deductible plans might save money by paying the cash price directly, as the insurance negotiated rates often exceed the cash amount. While the facility is a Critical Access Hospital with a voluntary non-profit ownership, the specific negotiated rates vary significantly across payers, ranging from a low of $32.00 to a high of $94.00 depending on the insurance plan. To minimize costs, patients should verify their specific plan's allowed amount and inquire about self-pay or prompt-pay discounts before scheduling, as these upfront incentives can reduce the final bill.
The facility's pricing is evaluated against federal benchmarks, where the Medicare amount of $8.62 serves as the baseline for determining fair value. Commercial rates are typically higher than Medicare due to administrative overhead and contract dynamics, but comparing the facility's cash price to the Medicare rate provides a clear view of the markup. It is important to note that hospitals often issue summary bills that obscure individual charges, so patients should request a full itemized statement to identify any unbundled codes or services not rendered. Additionally, under the No Surprises Act, patients are protected from balance billing for out-of-network services at in-network facilities, ensuring that unexpected charges for emergency or mandatory ancillary services are not applied.