Culture, bacterial
Facility: Wamego Health Center
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $135
- Cash Discount Price: $86
- vs. Medicare Baseline: 15.66x 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 1566% of the Medicare baseline (a markup of 1466%). 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 | $7 | 81% |
| Aetna | $8 | 93% |
| Medicaid / KanCare | $8 | 93% |
| Providrs Care | $9 | 104% |
| Blue Cross Blue Shield | $53 - $347 | 615% |
Consumer Guidance & Cost Commentary
For the bacterial culture procedure (CPT 87070) at Wamego Health Center, the cash median price is $86.00, which is significantly lower than the facility's negotiated rates of $135.00 and the gross charge of $216.00. While the facility is in-network for UnitedHealthcare, Aetna, Medicaid/KanCare, and Providrs Care, the negotiated rates for these payers range from $7 to $9, which are higher than the cash price. This pricing structure highlights a common billing dynamic where paying out-of-pocket can be more cost-effective than using insurance, especially if the patient's plan has a high deductible or if the insurer's negotiated rate exceeds the cash price. Patients should verify their specific plan's allowed amount before scheduling, as the facility offers a cash median that may result in lower out-of-pocket costs compared to standard insurance processing.
The facility's pricing is also evaluated against Medicare benchmarks, where the Medicare amount for this service is $8.62. The cash median of $86.00 represents a 15.7% increase over the Medicare rate, which falls within the typical range for fair pricing (120% to 150% of Medicare) and is considerably lower than the commercial negotiated rates. For patients concerned about balance billing or unexpected charges, it is important to note that the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, though patients should still request an itemized bill to ensure all charges are accurate. To maximize savings, patients should ask the billing department about prompt-pay discounts, which can reduce the final amount by 20