Culture, bacterial
Facility: Susan B Allen Memorial Hospital
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $554
- Cash Discount Price: $35
- vs. Medicare Baseline: 64.27x 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 6427% of the Medicare baseline (a markup of 6327%). 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 | $350 | 4060% |
| Providrs Care | $757 | 8782% |
Consumer Guidance & Cost Commentary
For this bacterial culture service at Susan B Allen Memorial Hospital in El Dorado, KS, the cash price is $35.00, which is lower than the facility's negotiated rates of $554.00 and the specific payer rates of $350.00 and $757.00. Because the cash price is significantly lower than the insurance negotiated amounts, patients with high-deductible plans may save money by paying out-of-pocket directly, provided they qualify for the cash rate. It is important to note that while the facility is a voluntary non-profit acute care hospital, the cash price does not automatically apply to all patients; you should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling to ensure you are not billed the higher insurance negotiated rate.
The Medicare benchmark for this service is $8.62, which serves as the objective baseline for evaluating the facility's pricing markup. The cash price of $35.00 represents a reasonable increase over the Medicare rate, whereas the negotiated rates of $350.00 and $757.00 reflect the administrative costs and contract dynamics of commercial insurance. If you receive a bill from this facility, you should request a full itemized CPT-coded statement rather than accepting a summary bill, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. If you are billed for the difference between the provider's full charge and the insurance allowed amount, you may be subject to balance billing, though the No Surprises Act protects you from such charges for emergency care and non-emergency services from out-of-network providers at in-network facilities.