CMS Price Transparency Data

Culture, bacterial

Facility: Adena Fayette Medical Center

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $30
Cash Discount Price: $24
vs. Medicare Baseline: 3.48x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at Adena Fayette Medical Center is $30. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $24. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 3.48x the Medicare baseline. Located in 1430 Columbus Avenue, Washington Ch, OH.

Cash / Self-Pay

$24

Average discount available for prompt cash payment at this facility.

Insurance Median

$30

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: $24 (278%)

Insurance Median: $30 (348%)

Cash: $24 (278% of Medicare)

Ins. Median: $30 (348% 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 348% of the Medicare baseline (a markup of 248%). 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
Blue Cross Blue Shield	$10 - $31	116%
Aetna	$19 - $62	220%
Buckeye Community Health Plan	$19	220%
Humana	$19	220%
Medical Mutual Of Ohio	$19 - $35	220%
Medigold	$19	220%
Molina	$19	220%
Care Source	$20	232%
Molina Marketplace	$21	244%
United Medical Resources Ohcp	$30	348%
UnitedHealthcare	$30	348%
Cigna	$32	371%
Ohio Ppo Connect	$33	383%
The Health Plan	$33	383%
Care Source Just4Me	$35	406%
Medical Mutual Of Ohio Supermed	$35	406%
First Health	$37 - $62	429%
Ohio Health Choice	$37	429%
Multiplan/Private Healthcare Systems	$45	522%
Sidecar Health	$53	615%

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 $24.
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 Adena Fayette Medical Center 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.