CMS Price Transparency Data

Culture, bacterial

Facility: Hermann Area District Hospital

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $41
Cash Discount Price: $56
vs. Medicare Baseline: 4.76x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at Hermann Area District Hospital is $41. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $56. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 4.76x the Medicare baseline. Located in 509 W 18Th St, Hermann, MO.

Cash / Self-Pay

$56

Average discount available for prompt cash payment at this facility.

Insurance Median

$41

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$8.62

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $8.62 (100%)

Cash / Self-Pay: $56 (650%)

Insurance Median: $41 (476%)

Cash: $56 (650% of Medicare)

Ins. Median: $41 (476% of 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 476% of the Medicare baseline (a markup of 376%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Coventry - All Plans	$2 - $9	23%
Cigna	$11 - $41	128%
Tricare	$11 - $40	128%
UnitedHealthcare	$11 - $43	128%
American Hlth Mcr Adv- All Plans	$12 - $45	139%
Blue Cross Blue Shield	$12 - $83	139%
Choicecare Mcr Adv- All Plans	$12 - $43	139%
Humana	$12 - $45	139%
Aetna	$13 - $97	151%
Wellcare Mcr Adv - All Plans	$13 - $46	151%
Harmony Hp Mcaid- All Plans	$16 - $59	186%
Healthcare Usa Mcaid- All Plans	$18 - $66	209%
Healthlink Hmo	$18 - $66	209%
Ambetter / Centene	$20 - $72	232%
Healthlink Ppo - All Other Plans	$21 - $76	244%
Multiplan/Phcs - All Plans	$21 - $76	244%
Comp Results - All Plans	$25 - $92	290%
Three Rivers - All Plans	$25 - $92	290%
Care Partners Mcaid- All Plans	$28 - $102	325%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $56.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 87070.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Hermann Area District Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 87070.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.