CMS Price Transparency Data

Culture, bacterial

Facility: Sanford Vermillion Medical Center

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $63
Cash Discount Price: $71
vs. Medicare Baseline: 7.31x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at Sanford Vermillion Medical Center is $63. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $71. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 7.31x the Medicare baseline. Located in 20 South Plum Street, Vermillion, SD.

Cash / Self-Pay

$71

Average discount available for prompt cash payment at this facility.

Insurance Median

$63

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: $71 (824%)

Insurance Median: $63 (731%)

Cash: $71 (824% of Medicare)

Ins. Median: $63 (731% 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 731% of the Medicare baseline (a markup of 631%). 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
Sanford Health Plan Align	$25 - $27	290%
Wellmark Sd	$26 - $28	302%
Aetna	$28 - $81	325%
Health Partners	$28 - $70	325%
Medicare (plans)	$28 - $31	325%
Ucare	$28 - $82	325%
UnitedHealthcare	$28 - $78	325%
Primewest	$29 - $31	336%
Sanford Health Plan	$34 - $49	394%
Security Health Plan	$47 - $51	545%
Medica	$70 - $82	812%
Wellmark	$73 - $81	847%
First Choice Health Network	$76 - $84	882%
Healthez	$76 - $84	882%
Multiplan	$76 - $84	882%

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 $71.
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 Sanford Vermillion 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.