CMS Price Transparency Data

Culture, bacterial

Facility: Harlem Hospital Center

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $43
Cash Discount Price: Unavailable
vs. Medicare Baseline: 4.99x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at Harlem Hospital Center is $43. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 4.99x the Medicare baseline. Located in 506 Lenox Avenue, New York, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$43

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%)

Insurance Median: $43 (499%)

Ins. Median: $43 (499% 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 499% of the Medicare baseline (a markup of 399%). 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
Aetna	$6 - $25	70%
Healthfirst	$7 - $97	81%
Elderplan	$9	104%
Fidelis	$9 - $97	104%
Magnacare	$10	116%
Oscar	$13	151%
Oxford	$13	151%
United	$13 - $54	151%
Centerlight	$18	209%
Cigna	$21	244%
Wellcare	$22	255%
Carelon	$23 - $43	267%
Emblem	$25 - $58	290%
Blue Cross Blue Shield	$28 - $97	325%
Multiplan	$29	336%
Local 1199	$31	360%
Villagecare Max	$31	360%
Vnsny	$31 - $44	360%
Metroplus	$42 - $97	487%
Amidacare	$43	499%
Senior Whole Health	$43	499%
United Behavioral Health	$43 - $48	499%
Affinity	$44 - $97	510%
Carelon (Amida Care)	$44	510%

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 $X.
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 Harlem Hospital Center 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.