Culture, bacterial
Facility: Children'S Mercy South
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $69
- Cash Discount Price: $50
- vs. Medicare Baseline: 8.00x 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 800% of the Medicare baseline (a markup of 700%). 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 | $8 - $414 | 93% |
| Healthy Blue | $8 - $24 | 93% |
| Medicaid / KanCare | $9 | 104% |
| Home State Health | $21 | 244% |
| Blue Cross Blue Shield | $32 - $456 | 371% |
| Cigna | $37 - $428 | 429% |
| Medica | $45 - $359 | 522% |
| Aetna | $47 - $419 | 545% |
| Wppa Providrs Care | $51 - $400 | 592% |
| Centivo | $51 - $400 | 592% |
| Quiktrip | $51 - $401 | 592% |
| Orscheln | $51 - $400 | 592% |
| Nebraska Furniture Mart | $51 - $400 | 592% |
| Wellfit/Centrus | $51 - $400 | 592% |
| Health Midwest Comprehensive Care | $51 - $401 | 592% |
| Humana | $52 - $410 | 603% |
| Coventry Health Care Of Kansas | $58 - $456 | 673% |
| Coxhealth Network | $58 - $456 | 673% |
| Mercy Health | $58 - $462 | 673% |
| Multiplan | $59 - $468 | 684% |
| American Healthcare Alliance | $66 - $524 | 766% |
| Healthlink | $69 - $542 | 800% |
| National Preferred Provider Network | $70 - $554 | 812% |
Consumer Guidance & Cost Commentary
For the bacterial culture service (CPT 87070) at Children's Mercy South in Overland Park, the facility's cash median price of $50.00 is significantly lower than the negotiated rates paid by major insurers, which range from $8 to $554 across 23 different payers. While the facility's gross charge is $104.00, the Medicare benchmark of $8.62 serves as the most reliable baseline for understanding true cost, with commercial negotiated rates often exceeding 200% of this federal rate. Patients with high-deductible plans may find paying the cash price of $50.00 more cost-effective than relying on insurance, as many commercial payers have negotiated rates that far exceed the cash amount. To maximize savings, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed before any insurance claim is processed.
It is important to distinguish between the facility's negotiated rates and the potential for balance billing, especially regarding ancillary services like laboratory tests. Although the No Surprises Act protects patients from balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, patients should still verify that all components of their care are covered under their plan. If a patient receives a bill that exceeds the cash price or the allowed amount, they should request a formal, itemized billing audit to identify errors such as double-billing or unbundled codes, as over 80% of hospital bills contain inaccuracies. Disputing these charges in writing, rather than accepting summary bills or verbal assurances, is the most effective way to ensure