Culture, bacterial
Facility: Bob Wilson Memorial Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $72
- Cash Discount Price: $35
- vs. Medicare Baseline: 8.35x 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 835% of the Medicare baseline (a markup of 735%). 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 |
|---|---|---|
| Centura Employee Plan | $11 | 128% |
| Medicare (plans) | $28 | 325% |
| Kansas Health | $28 | 325% |
| Humana | $28 | 325% |
| Aetna | $28 - $71 | 325% |
| UnitedHealthcare | $28 - $74 | 325% |
| Blue Cross Blue Shield | $43 | 499% |
| Multiplan | $80 - $82 | 928% |
| Health Partners Of Kansas | $83 | 963% |
| Wppa | $84 | 974% |
Consumer Guidance & Cost Commentary
For the bacterial culture service (CPT 87070) at Bob Wilson Memorial Hospital in Ulysses, KS, the facility's cash median price of $35.00 is significantly lower than the negotiated rates paid by most commercial payers, which range from $28 to $84. While Medicare sets a benchmark of $8.62, the hospital's cash rate is roughly four times higher than the Medicare amount, yet it remains the most affordable option for patients without insurance. This pricing structure highlights a common billing dynamic where commercial negotiated rates often exceed cash prices due to administrative costs and contract structures; however, patients with high-deductible plans may find the cash price more favorable if their insurance allowed amount is higher than $35.00.
To ensure you receive the best possible rate, it is important to verify your specific plan's negotiated amount before scheduling, as in-network rates vary widely among the ten payers listed, with some charging up to $84.00. If you choose to pay out-of-pocket, you should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can further reduce the $35.00 cash median. Additionally, if you receive a summary bill, request a full itemized statement to identify any unbundled codes or services not rendered, as these errors can inflate your total. Remember that the No Surprises Act protects you from balance billing for out-of-network services at in-network facilities, so do not pay a surprise bill immediately without first disputing it with your insurer.