Culture, bacterial
Facility: Decatur Health
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $48
- Cash Discount Price: $54
- vs. Medicare Baseline: 5.57x 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 557% of the Medicare baseline (a markup of 457%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $34 - $38 | 394% |
| UnitedHealthcare | $34 - $48 | 394% |
| Humana | $35 - $39 | 406% |
| Blue Cross Blue Shield | $41 | 476% |
| Midlands Choice- All Plans | $51 - $57 | 592% |
| Aetna | $51 - $63 | 592% |
| Medicaid / KanCare | $57 - $64 | 661% |
Consumer Guidance & Cost Commentary
For this bacterial culture service at Decatur Health in Oberlin, Kansas, the negotiated rates paid by insurance carriers range from $34 to $64, with a median negotiated amount of $48.00. This facility is a Critical Access Hospital, and its pricing structure is significantly higher than the state average; the Medicare benchmark for this service is $8.62, which serves as the objective baseline for fair pricing. While commercial insurance contracts often inflate baseline prices by 20% to 40% due to administrative overhead, the facility's cash price of $54.00 remains notably above the Medicare rate. For patients with high-deductible plans, paying the cash price directly may be more cost-effective than relying on insurance, as the negotiated rates can sometimes exceed the cash price, especially when administrative costs are factored in.
Patients should be aware that assuming an in-network status guarantees the lowest possible price is a common pitfall, as different insurers negotiate different rates, and some facilities charge significantly more than others. To minimize costs, it is advisable to verify the specific allowed amount for your plan before scheduling and to explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% if paid upfront. Additionally, if you receive a bill after using insurance, request a full itemized CPT-coded 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.