Culture, bacterial
Facility: Medicine Lodge Memorial Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $52
- Cash Discount Price: $55
- vs. Medicare Baseline: 6.03x 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 603% of the Medicare baseline (a markup of 503%). 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 |
|---|---|---|
| Tricare | $32 - $104 | 371% |
| Humana | $36 - $118 | 418% |
| Aetna | $37 - $129 | 429% |
| UnitedHealthcare | $38 - $123 | 441% |
| Hpk-All Plans | $38 - $123 | 441% |
| Medicaid / KanCare | $40 - $129 | 464% |
Consumer Guidance & Cost Commentary
For this bacterial culture service at Medicine Lodge Memorial Hospital, the cash price of $55.00 is identical to the facility's median negotiated rate of $52.00 and the median paid amount of $51.00. While the gross charge listed is $55.00, patients with high-deductible plans may find paying cash directly more cost-effective than relying on insurance, as the negotiated rates from payers like Tricare, Humana, and Aetna range from $32 to $129, often exceeding the cash price. To secure the lowest possible cost, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees.
When evaluating this price against broader benchmarks, the Medicare amount for this procedure is $8.62, which serves as the objective baseline for fair pricing. Although the facility's cash rate of $55.00 is significantly higher than the Medicare amount, it aligns closely with the state and county averages for Critical Access Hospitals in Kansas, where commercial negotiated rates typically reflect the administrative load of insurance billing cycles. Because the cash price matches the median negotiated rate, there is no additional markup for using insurance for this specific service, but patients should still verify their specific plan's deductible status and allowed amounts to ensure they are not paying more than necessary.