CMS Price Transparency Data

Culture, bacterial

Facility: Lexington Memorial Hospital Inc

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $82
Cash Discount Price: $93
vs. Medicare Baseline: 9.51x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at Lexington Memorial Hospital Inc is $82. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $93. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 9.51x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$93

Average discount available for prompt cash payment at this facility.

Insurance Median

$82

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: $93 (1079%)

Insurance Median: $82 (951%)

Cash: $93 (1079% of Medicare)

Ins. Median: $82 (951% 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 951% of the Medicare baseline (a markup of 851%). 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
Alliance	$16	186%
Amerihealth	$16 - $28	186%
Carolina Complete	$16	186%
Healthy Blue	$16	186%
Partners	$16	186%
Trillium	$16	186%
UnitedHealthcare	$16 - $83	186%
Vaya	$16	186%
Wellcare	$16	186%
Blue Cross Blue Shield	$27 - $44	313%
Ambetter / Centene	$28	325%
Medcost	$41 - $124	476%
Aetna	$53 - $172	615%
Oscar	$60 - $82	696%
Cigna	$81 - $82	940%
Directnet	$110	1276%
Healthgram Lexington Home Brands	$134	1555%
Healthgram	$149	1729%
Private Healthcare Systems	$153	1775%
Beechstreet	$164	1903%
Humana	$164	1903%
Multiplan	$167	1937%
National Provider Network	$167	1937%

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 $93.
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 Lexington Memorial Hospital Inc 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.