Culture, bacterial
Facility: Clay County Medical Center
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $43
- Cash Discount Price: $46
- vs. Medicare Baseline: 4.99x 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 499% of the Medicare baseline (a markup of 399%). 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 | $28 - $194 | 325% |
| Wppa/Providrs Care- All Plans | $28 - $194 | 325% |
| UnitedHealthcare | $29 - $198 | 336% |
| Health Partners - All Plans | $29 - $198 | 336% |
| Multiplan- All Plans | $29 - $198 | 336% |
Consumer Guidance & Cost Commentary
For this bacterial culture service at Clay County Medical Center in Clay Center, KS, the cash price of $46.00 is significantly lower than the negotiated rates charged by major insurance carriers like Aetna, UnitedHealthcare, and Health Partners, which range from $28 to $198 depending on the specific plan. While the facility's cash rate matches the state median of $46.00, it is notably higher than the national average for this procedure, which sits at $42.00. Patients with high-deductible plans may find paying the cash price directly more advantageous than using insurance, as the negotiated rates often exceed the cash amount, potentially resulting in higher out-of-pocket costs after deductibles are met. It is important to verify if your specific plan has a lower allowed amount than the cash price before scheduling, as paying out-of-pocket could save you money in this instance.
To ensure you are not overcharged, always request an itemized bill that breaks down the specific CPT code 87070 rather than accepting a summary invoice that groups the cost under broad categories like "Laboratory." If you receive a balance bill for the difference between the provider's full charge and your insurance payment, remember that the No Surprises Act generally prohibits these unexpected charges for emergency care and non-emergency services at in-network facilities. Additionally, ask the billing department about prompt-pay discounts, which can reduce the final amount by 20% to 50% if you settle the bill upfront, effectively bypassing the administrative costs associated with insurance claims processing.