Culture, bacterial
Facility: Community Memorial Healthcare, Inc.
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $50
- Cash Discount Price: $94
- vs. Medicare Baseline: 5.80x 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 580% of the Medicare baseline (a markup of 480%). 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 |
|---|---|---|
| Aetna | $18 - $271 | 209% |
| UnitedHealthcare | $22 - $206 | 255% |
| Blue Cross Blue Shield | $32 | 371% |
Consumer Guidance & Cost Commentary
For this bacterial culture service at Community Memorial Healthcare in Marysville, Kansas, the cash price is $94.00, which matches the facility's median negotiated rate. While the facility's negotiated rate of $50.00 is lower than the cash price, patients with high-deductible plans may find paying out-of-pocket cheaper if their insurance allowed amount exceeds $94.00. It is important to note that commercial insurance rates often include administrative overhead, making the cash price a more direct comparison for self-pay patients. Additionally, the facility's cash rate of $94.00 is significantly higher than the state average of $5.82, suggesting that commercial pricing in this area may be elevated compared to the baseline set by federal reimbursement standards.
Patients should be aware that balance billing can occur if they receive care from out-of-network providers, though the No Surprises Act protects against surprise bills for emergency services and non-emergency care at in-network facilities. If you receive a bill that seems unexpectedly high, request a formal itemized audit to verify that all charges correspond to services actually rendered and that no unbundled codes or duplicate billing has occurred. Furthermore, you may be eligible for a prompt-pay discount if you choose to settle the bill in full upfront, as hospitals often offer reduced rates for immediate cash payments to bypass costly insurance claims processing. Always confirm with the billing department whether a "self-pay" or "prompt-pay" discount is available before scheduling your visit to ensure you are aware of the most favorable payment option.