Culture, bacterial
Facility: Sheridan County Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $42
- Cash Discount Price: $53
- 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 |
|---|---|---|
| Celtic Insurance | $8 - $130 | 93% |
| UnitedHealthcare | $13 - $204 | 151% |
| Blue Cross Blue Shield | $14 - $44 | 162% |
Consumer Guidance & Cost Commentary
For the CPT code 87070 (Culture, bacterial) at Sheridan County Hospital in Hoxie, KS, the cash price is $53.00, which matches the facility's median negotiated rate of $42.00 and the cash median. This service is significantly more expensive than the Medicare benchmark of $8.62, reflecting a markup common in commercial billing where administrative costs and contract dynamics often inflate prices beyond the true cost of care. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that commercial rates can sometimes exceed cash prices; however, in this specific case, the cash price is the lowest available option compared to the negotiated rates typically seen with insurers like UnitedHealthcare, Blue Cross Blue Shield, and Celtic Insurance.
To minimize potential costs, patients should verify if their specific insurance plan has a deductible that has already been met, as paying out-of-pocket might be more expensive if the insurer's allowed amount is high. Additionally, since the facility is a Critical Access Hospital, patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can bypass the administrative overhead of insurance claims processing. If a balance bill arises from an out-of-network ancillary service, patients should not pay immediately but instead request a formal itemized audit to identify unbundled codes or services not rendered, ensuring they are not overcharged for the bacterial culture procedure.