Culture, bacterial
Facility: Fredonia Regional Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $51
- Cash Discount Price: $62
- vs. Medicare Baseline: 5.92x 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 592% of the Medicare baseline (a markup of 492%). 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 |
|---|---|---|
| UnitedHealthcare | $5 - $61 | 58% |
| Blue Cross Blue Shield | $28 - $34 | 325% |
| Aetna | $29 - $61 | 336% |
| Veterans Programs - All Plans | $29 - $35 | 336% |
| Reserve National-All Plans | $51 - $61 | 592% |
| Meritain-All Plans | $51 - $61 | 592% |
| Cigna | $51 - $61 | 592% |
Consumer Guidance & Cost Commentary
For the CPT code 87070 (Culture, bacterial) at Fredonia Regional Hospital in Kansas, the cash price is $62.00, which matches the facility's median paid amount. This cash rate is significantly lower than the facility's negotiated rates, which range from $28 to $61 depending on the insurance plan, with UnitedHealthcare and Aetna showing the widest spread. While the facility is a Critical Access Hospital with government local ownership, the cash price of $62.00 is notably higher than the Medicare benchmark of $8.62, reflecting the typical markup found in commercial pricing. Patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount, potentially leading to higher out-of-pocket costs if the patient's deductible has not yet been met.
To minimize unexpected costs, consumers should verify whether "self-pay" or "prompt-pay" discounts are available before scheduling, as these can reduce the final bill by 20% to 50%. It is also important to request an itemized billing audit, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that could lower the total charge. If a patient receives a balance bill for an out-of-network service, they should not pay immediately but instead dispute the bill with their insurer under the No Surprises Act, which protects against surprise billing for emergency care and non-emergency services at in-network facilities. Always compare the final allowed amount to the Medicare rate to ensure the facility is charging a fair price relative to the true cost of care.