Culture, bacterial
Facility: Memorial Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $40
- Cash Discount Price: $63
- 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 |
|---|---|---|
| Blue Cross Blue Shield | $22 | 255% |
| Humana | $26 - $37 | 302% |
| Tricare | $26 - $37 | 302% |
| Medicare (plans) | $27 - $37 | 313% |
| Ambetter / Centene | $29 - $40 | 336% |
| Coventry - All Other Plans | $47 - $66 | 545% |
| Health Partners Of Kansas - All Plans | $50 - $70 | 580% |
| Preferred Healthcare-All Plans | $50 - $70 | 580% |
| Wppa/Providers Care-All Plans | $74 - $103 | 858% |
Consumer Guidance & Cost Commentary
For this bacterial culture service at Memorial Hospital in Abilene, KS, the cash price is $63.00, which matches the facility's median paid amount. While commercial insurance plans like Blue Cross Blue Shield and Humana negotiate rates ranging from $22 to $70, these negotiated amounts are often higher than the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash rate of $63.00 directly, as this avoids the potential for balance billing if their insurance allows a lower negotiated rate that still exceeds the cash price. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still verify their specific plan's allowed amount before scheduling to ensure they are not facing unexpected costs.
To minimize medical debt, consumers should request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, patients should inquire about prompt-pay discounts, which can reduce the $63.00 cash price by 20% to 50% if paid in full upfront, bypassing the costly insurance claims cycle. Since the facility is a Critical Access Hospital owned by a government hospital district, pricing transparency is a priority, but patients must still confirm their specific coverage details. Comparisons to state or county averages are not available in this dataset, so the focus remains on understanding the direct cash rate versus the facility's negotiated rates for various payers.