CMS Price Transparency Data

Culture, bacterial

Facility: The Outer Banks Hospital, Inc

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $123
Cash Discount Price: $118
vs. Medicare Baseline: 14.27x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at The Outer Banks Hospital, Inc is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $118. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 14.27x the Medicare baseline. Located in 4800 South Croatan Highway, Nags Head, NC.

Cash / Self-Pay

$118

Average discount available for prompt cash payment at this facility.

Insurance Median

$123

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: $118 (1369%)

Insurance Median: $123 (1427%)

Cash: $118 (1369% of Medicare)

Ins. Median: $123 (1427% 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 1427% of the Medicare baseline (a markup of 1327%). 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
Blue Cross Blue Shield	$8 - $137	93%
Aetna	$9 - $175	104%
Humana	$9	104%
Liberty Advantage [1313]	$10 - $82	116%
UnitedHealthcare	$10 - $131	116%
Trillium [1296]	$11	128%
Longevity Health [1411]	$12 - $101	139%
Amerihealth McAid Adv [1316]	$16	186%
Nc Dept of Public Safety [1095]	$16 - $140	186%
Wellcare [1320]	$16	186%
Carolina Complete Health [1317]	$16	186%
Medcost [1067]	$17 - $150	197%
Cigna	$22 - $212	255%
Multiplan [1031]	$25 - $212	290%

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 $118.
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 The Outer Banks 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.