Culture, bacterial
Facility: Great Plains Of Sabetha
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $34
- Cash Discount Price: $41
- vs. Medicare Baseline: 3.94x 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 394% of the Medicare baseline (a markup of 294%). 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 |
|---|---|---|
| Celtic Mcr Adv | $18 - $25 | 209% |
| Aetna | $18 - $48 | 209% |
| Celtic Comm Exchange-All Other Plans | $22 - $31 | 255% |
| Great West Healthcare-All Plans | $29 - $40 | 336% |
| UnitedHealthcare | $32 - $48 | 371% |
| Humana | $32 - $45 | 371% |
| Multiplan-Phcs-All Plans | $32 - $45 | 371% |
| Cigna | $32 - $45 | 371% |
| Century/Wppa/Providers-All Plans | $32 - $45 | 371% |
| Federated Mutual Ins-All Plans | $33 - $46 | 383% |
| Blue Cross Blue Shield | $34 - $48 | 394% |
| Medicaid / KanCare | $34 - $48 | 394% |
Consumer Guidance & Cost Commentary
For this bacterial culture service (CPT 87070), the facility's cash price of $41.00 is identical to the state average, while the median negotiated rate across 12 payers is $34.00. This indicates that paying out-of-pocket directly may result in a higher cost than what insurance plans negotiate, as the cash price exceeds the median allowed amount of $32.00. Patients with high-deductible plans should verify if their specific insurance plan's negotiated rate is lower than the cash price before scheduling, as paying cash could inadvertently cost more than the insurer would have paid. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if settled upfront, bypassing the administrative costs associated with insurance claims processing.
It is important to understand that commercial negotiated rates often include administrative overhead, which can inflate the baseline price by 20% to 40% compared to the true cost of care. To ensure you are receiving a fair price, you should compare your facility's rates against the Medicare benchmark of $8.62, which serves as a scientifically validated cost baseline. While the facility's rates are significantly higher than the Medicare amount, this markup is standard for commercial contracts; however, patients should avoid assuming that being in-network guarantees the lowest possible price, as different insurers negotiate varying rates. If you receive a bill, always request a full itemized statement to identify any errors or unbundled charges, as over 80% of hospital bills contain mistakes that can be corrected through a formal written audit dispute.