CMS Price Transparency Data

Culture, bacterial

Facility: Pawhuska Hospital, Inc

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $92
Cash Discount Price: $73
vs. Medicare Baseline: 10.67x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at Pawhuska Hospital, Inc is $92. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $73. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 10.67x the Medicare baseline. Located in 1101 East 15Th Street, Pawhuska, OK.

Cash / Self-Pay

$73

Average discount available for prompt cash payment at this facility.

Insurance Median

$92

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: $73 (847%)

Insurance Median: $92 (1067%)

Cash: $73 (847% of Medicare)

Ins. Median: $92 (1067% 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 1067% of the Medicare baseline (a markup of 967%). 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
UnitedHealthcare	$11 - $90	128%
Healthchoice Ip/Op Only - All Plans	$14	162%
Community Care Comm - All Plans	$22	255%
Blue Cross Blue Shield	$65 - $106	754%
Aetna	$72 - $125	835%
Tricare	$72	835%
Wellcare Mcr Adv - All Plans	$72	835%
Humana	$73 - $125	847%
Healthcare Highways - All Plans	$81	940%
Cigna	$85	986%
Multiplan - All Plans	$94	1090%
Ambetter / Centene	$109	1265%
Preferred Commchoice Ip/Op Only - All Plans	$112	1299%
Soonerselect Mcaid - All Plans	$125	1450%

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 $73.
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 Pawhuska Hospital, Inc 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.