Culture, bacterial
Facility: Northeast Regional Medical Center
Billing Code: 87070 (CPT)
- CPT Billing Code: 87070
- Insurance Median: $164
- Cash Discount Price: $182
- vs. Medicare Baseline: 19.03x 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 1903% of the Medicare baseline (a markup of 1803%). 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 |
|---|---|---|
| Node Champva | $8 | 93% |
| Medicaid / KanCare | $8 - $13 | 93% |
| Medicare (plans) | $8 | 93% |
| Tricare | $8 | 93% |
| UnitedHealthcare | $9 - $346 | 104% |
| Blue Prefrerred | $9 | 104% |
| Node Hospice Non Par Agree | $9 | 104% |
| Blue Access | $9 | 104% |
| Node VA | $9 | 104% |
| Veterans Eval Services | $9 | 104% |
| Blue Pathway/Pathway X | $9 | 104% |
| Blue Cross Blue Shield | $9 - $141 | 104% |
| Node Devoted Health McR Adv | $9 | 104% |
| Centurion Correctional | $11 | 128% |
| Us Department of Labor | $11 | 128% |
| Home State Exchange | $16 | 186% |
| Naphcare | $16 | 186% |
| Immergrun | $17 | 197% |
| Self Pay | $111 - $254 | 1288% |
| Cigna | $157 - $181 | 1821% |
| Aetna | $172 - $385 | 1995% |
| Access Health Services, LLC | $300 | 3480% |
| Healthlink | $346 - $370 | 4014% |
| Multiplan | $346 - $370 | 4014% |
| Coventry Wc | $370 | 4292% |
Consumer Guidance & Cost Commentary
For patients paying out-of-pocket, the most important fact to know immediately is that the cash price for CPT code 87070 at Northeast Regional Medical Center in Kirksville, Missouri, is $182. While commercial insurance plans often negotiate rates higher than the cash price due to administrative overhead and contract structures, self-pay patients should verify if the facility offers prompt-pay discounts before scheduling, as paying upfront can sometimes result in a lower total than what insurance might allow. This specific procedure's cash rate is significantly lower than the facility's gross charge of $462, highlighting the potential savings available when paying directly rather than relying on standard billing cycles.
When viewed against broader pricing benchmarks, the facility's cash rate of $182 is notably higher than the state average of $8.62, though it remains below the gross chargemaster price. For those with high-deductible plans where the insurance negotiated rate exceeds the cash price, paying directly could be the more economical choice. It is crucial for consumers to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors that can be corrected. Additionally, while Medicare sets a benchmark of $8.62 for this service, commercial rates vary widely by payer, with some plans like Aetna negotiating up to $385 and others like Medicaid / KanCare at $13, making direct comparison of allowed amounts essential before booking an appointment.