Culture, bacterial
Facility: Centura St. Catherine-Dodge City
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $252
- Cash Discount Price: $153
- vs. Medicare Baseline: 29.23x 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 2923% of the Medicare baseline (a markup of 2823%). 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 |
|---|---|---|
| Medicare (plans) | $9 | 104% |
| Aetna | $9 - $306 | 104% |
| Humana | $9 | 104% |
| Kansas Health | $9 | 104% |
| Blue Cross Blue Shield | $9 - $37 | 104% |
| Cigna | $9 | 104% |
| Kaiser | $9 | 104% |
| Centura Employee Plan | $11 | 128% |
| UnitedHealthcare | $252 | 2923% |
| Wpaa | $268 | 3109% |
| Christian Health Aid | $306 | 3550% |
| Multiplan | $306 - $345 | 3550% |
| Health Partners Of Kansas | $345 | 4002% |
Consumer Guidance & Cost Commentary
For the bacterial culture service (CPT 87070), the facility's cash median price of $153.00 is significantly lower than the average negotiated rates paid by commercial insurers, which range from $252.00 to $345.00 depending on the plan. This price difference highlights a potential opportunity for patients with high-deductible plans or those without insurance, as paying cash directly can result in substantial savings compared to the amounts commercial payers like UnitedHealthcare, Multiplan, and Christian Health Aid typically negotiate. However, patients should be aware that commercial rates often include administrative overhead and contract premiums that do not apply to self-pay patients, making the cash price the most transparent baseline for comparison.
While the facility's cash rate is competitive, it is important to note that Medicare reimbursement for this specific code is set at $8.62, which serves as the federal benchmark for true cost. The facility's cash price of $153.00 represents a markup relative to this federal baseline, a common practice in the healthcare industry where commercial rates are often 200% to 300% of Medicare amounts. To ensure you receive the best possible rate, we recommend contacting the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill. Additionally, if you have insurance, verify your specific plan's allowed amount before scheduling, as some commercial contracts may exceed the cash price, while others might offer lower negotiated rates that could be more favorable depending on your deductible status.