Culture, bacterial
Facility: Trego County Lemke Memorial Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $31
- Cash Discount Price: $36
- vs. Medicare Baseline: 3.60x 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 360% of the Medicare baseline (a markup of 260%). 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 |
|---|---|---|
| Va Ccn - All Plans | $3 - $4 | 35% |
| Humana | $17 - $24 | 197% |
| Tricare | $19 - $26 | 220% |
| UnitedHealthcare | $22 - $50 | 255% |
| Medicaid / KanCare | $22 - $50 | 255% |
| Aetna | $22 - $45 | 255% |
| Ambetter / Centene | $24 - $34 | 278% |
| Health Partners - All Plans | $33 - $48 | 383% |
| Healthy Blue Mcaid - All Plans | $35 - $50 | 406% |
| Blue Cross Blue Shield | $44 | 510% |
Consumer Guidance & Cost Commentary
For the bacterial culture service (CPT 87070) at Trego County Lemke Memorial Hospital, the cash price of $36.00 is significantly lower than the facility's gross charge of $43.00. While the hospital is a Critical Access Hospital in Wakeeney, KS, with government-local ownership, the cash rate remains competitive compared to the state average, which is typically 120% to 150% of the Medicare benchmark of $8.62. Patients with high-deductible plans or those without insurance may find the cash price advantageous, as it is lower than the median negotiated rate of $31.00 paid by most insurance payers. However, because the cash price is only slightly higher than the median paid amount, the financial benefit of paying out-of-pocket diminishes unless the patient's specific insurance plan has a negotiated rate exceeding $36.00.
Insurance coverage varies widely across the ten payers represented, with allowed amounts ranging from a low of $3.00 for some plans to a high of $50.00 for others. Notably, Medicaid/KanCare and Healthy Blue Medicaid plans have negotiated rates at the maximum of $50.00, which exceeds the cash price, making self-pay a potentially cheaper option for these beneficiaries. To maximize savings, patients should request a prompt-pay discount before scheduling, as paying the bill in full upfront can often reduce the total cost by 20% to 50%. It is also important to verify that the facility is billing under a self-pay classification rather than submitting a claim to insurance, which could void any cash discount agreement and result in a balance