Culture, bacterial
Facility: William Newton Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $58
- Cash Discount Price: $112
- vs. Medicare Baseline: 6.73x 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 673% of the Medicare baseline (a markup of 573%). 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 | $7 - $585 | 81% |
| Ambetter / Centene | $29 - $650 | 336% |
| Blue Cross Blue Shield | $29 - $234 | 336% |
| Triwest- All Plans | $29 - $227 | 336% |
| Providrs Care Nexus | $50 - $398 | 580% |
| Providrs Care - All Other Plans | $57 - $455 | 661% |
Consumer Guidance & Cost Commentary
For the CPT code 87070 (Culture, bacterial) at William Newton Hospital in Winfield, KS, the cash price is $112.00, which matches the facility's median paid amount. This cash rate is significantly lower than the negotiated rates charged to insurance plans, which range from $29 to $650 across six payers. While the facility is a Critical Access Hospital owned by the local government, 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. To minimize out-of-pocket costs, it is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill.
When evaluating this charge, it is important to compare the facility's pricing against objective benchmarks rather than the inflated chargemaster list. The Medicare amount for this service is $8.62, and the facility's cash rate of $112.00 represents a markup of 6.7 times the Medicare rate. Although commercial negotiated rates typically average 200% to 300% of Medicare, the specific negotiated rates here vary widely by insurer. Consumers should be aware of balance billing risks if services are rendered out-of-network, though the No Surprises Act protects emergency care and non-emergency services at in-network facilities. If you receive a bill, always request a full itemized statement to verify that no unbundled codes or services not rendered have been included, as over 80% of hospital bills contain errors that can be corrected through a formal audit dispute.