CMS Price Transparency Data

Culture, bacterial

Facility: Nemours Childrens Hospital, Florida

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $51
Cash Discount Price: $176
vs. Medicare Baseline: 5.92x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at Nemours Childrens Hospital, Florida is $51. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $176. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 5.92x the Medicare baseline. Located in 6535 Nemours Pkwy, Orlando, FL.

Cash / Self-Pay

$176

Average discount available for prompt cash payment at this facility.

Insurance Median

$51

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: $176 (2042%)

Insurance Median: $51 (592%)

Cash: $176 (2042% of Medicare)

Ins. Median: $51 (592% 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 592% of the Medicare baseline (a markup of 492%). 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
Tricare	$8	93%
UnitedHealthcare	$8	93%
Cigna	$11 - $126	128%
Avmed	$12 - $96	139%
Employers Health Network Fl	$16 - $124	186%
Florida Blue	$16 - $190	186%
Truli	$16 - $124	186%
Aetna	$18 - $137	209%
Evolutions Healthcare	$18 - $140	209%
Integra Administrative Group	$24 - $187	278%
Global Medical Management	$26 - $202	302%
Prime Health Services	$26 - $202	302%
Star Healthcare Network	$26 - $202	302%
Velocity	$30 - $233	348%
First Health Network	$31 - $243	360%
Pnoa	$32 - $249	371%
Seminole Tribe Of Fl	$32 - $249	371%
Private Healthcare Systems	$37 - $286	429%

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 $176.
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 Nemours Childrens Hospital, Florida 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.