Culture, bacterial
Facility: Hiawatha Community Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $82
- Cash Discount Price: $119
- vs. Medicare Baseline: 9.51x 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 951% of the Medicare baseline (a markup of 851%). 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 | $30 - $32 | 348% |
| UnitedHealthcare | $31 - $149 | 360% |
| Aetna | $31 - $140 | 360% |
| Humana | $32 - $65 | 371% |
| Ambetter / Centene | $38 - $77 | 441% |
| Centrus Health Direct - All Plans | $64 - $130 | 742% |
| Oscar - All Plans | $64 - $130 | 742% |
| Preferred Hlth - All Plans | $76 - $156 | 882% |
| Cigna | $81 - $164 | 940% |
| Wppa Providrs Care - All Plans | $81 - $164 | 940% |
| Multiplan - All Plans | $82 - $168 | 951% |
| Midlands Choice - All Plans | $82 - $168 | 951% |
| Healthy Blue Mcaid - All Plans | $85 - $173 | 986% |
Consumer Guidance & Cost Commentary
For the bacterial culture service (CPT 87070) at Hiawatha Community Hospital in Hiawatha, KS, the facility's cash price of $119.00 is significantly higher than the state average, which sits at $89.00. While this represents a premium compared to the typical cost in Kansas, it is important to note that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. For patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price of $119.00 upfront could result in immediate savings, as many commercial payers in this region negotiate rates that are higher than the cash-pay option.
To minimize costs, patients should proactively contact the hospital to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full before or shortly after the service. Additionally, since the facility is a Critical Access Hospital, the No Surprises Act provides protection against balance billing for out-of-network services, ensuring that unexpected charges for emergency or non-emergency care from out-of-network providers at this in-network facility are not applied. Before scheduling, it is advisable to verify the specific allowed amount for your insurance plan, as negotiated rates vary widely among the 13 commercial payers listed, ranging from $30 to $173, and ensure that any billing disputes are handled in writing to protect your rights.