Culture, bacterial
Facility: Smith County Memorial Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $40
- Cash Discount Price: $45
- vs. Medicare Baseline: 4.64x 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 464% of the Medicare baseline (a markup of 364%). 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 |
|---|---|---|
| Medicaid / KanCare | $28 - $49 | 325% |
| Blue Cross Blue Shield | $32 | 371% |
| Multiplan-All Plans | $36 - $44 | 418% |
| Health Partners Of Ks Ppo-All Plans | $38 - $46 | 441% |
| Wppa-All Plans | $38 - $46 | 441% |
| UnitedHealthcare | $38 - $46 | 441% |
| Midlands Choice-All Plans | $38 - $46 | 441% |
Consumer Guidance & Cost Commentary
For the bacterial culture service (CPT 87070) at Smith County Memorial Hospital in Smith Center, KS, the cash price is $45.00, which matches the facility's median negotiated rate of $40.00 and the state average of $41.00. While this service is covered by seven payers including Medicaid/KanCare, Blue Cross Blue Shield, and UnitedHealthcare, the cash price remains consistent across the board. Patients with high-deductible plans may find paying the $45.00 cash price directly more cost-effective than relying on insurance, as the negotiated rates for these plans range from $32.00 to $49.00 depending on the specific carrier. It is important to note that while insurance typically covers the service, the actual amount paid by the insurer varies by plan, and the cash price does not automatically include any potential prompt-pay discounts that might be available for upfront payment.
To ensure you receive the most favorable rate, you should explicitly ask the hospital to classify your visit as self-pay before scheduling to access prompt-pay discounts, which can reduce the bill by 20% to 50% if paid in full within 30 days. Since this facility is a Critical Access Hospital owned by the local government, they may offer additional financial assistance or sliding scale fees not reflected in the standard billing data. If you choose to use insurance, be aware that balance billing is generally prohibited for emergency care under the No Surprises Act, but you should still request an itemized bill to verify that no unexpected charges for services not rendered or unbundled codes are included. Always compare the final allowed amount from your insurer against the