CMS Price Transparency Data

Culture, bacterial

Facility: St Mary Medical Center

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 87070
  • Insurance Median: $126
  • Cash Discount Price: $268
  • vs. Medicare Baseline: 14.62x Medicare
The contracted insurance negotiated median rate for a Culture, bacterial at St Mary Medical Center is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $268. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 14.62x the Medicare baseline. Located in Langhorne-Newtown Rd, Langhorne, PA.
Cash / Self-Pay
$268

Average discount available for prompt cash payment at this facility.

Insurance Median
$126

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: $268 (3109%)
Insurance Median: $126 (1462%)
Cash: $268 (3109% of Medicare)
Ins. Median: $126 (1462% 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 1462% of the Medicare baseline (a markup of 1362%). 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.

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
Medicaid / KanCare $8 - $782 93%
Aetna $9 - $1,035 104%
Align Senior Care $9 - $997 104%
Blue Cross Blue Shield $9 - $4,967 104%
Cigna $9 - $3,782 104%
Medicare (plans) $9 - $1,760 104%
Health America Advantra $10 - $1,173 116%
UnitedHealthcare $11 - $3,742 128%
Pace-Trinity Health $14 - $41 162%
Ambetter / Centene $15 - $1,745 174%
Jefferson Health Plan Commercial $16 - $1,780 186%
Oscar $16 - $1,760 186%
Prime Healthcare $16 - $1,760 186%
Homestead Health Plans Woods Center $17 - $1,907 197%
Keystone First $17 197%
Keystone First Chip $17 197%
Group Pension Administrators $19 - $2,200 220%
Reedman Toll $19 - $2,200 220%
Blue Shield - Pa (Highmark) $23 - $2,644 267%
Amerihealth $46 - $2,213 534%
Blue Shield - Ca $46 - $2,213 534%
Blue Shield - Id (Regence) $46 - $2,213 534%
Blue Shield - Ny Highmark Western $46 - $2,213 534%
Blue Shield - Wa (Regence) $46 - $2,213 534%
Upmc Health Plan $46 - $3,782 534%
Webtpa $46 - $3,782 534%
Geha $58 - $3,742 673%
Meritain $126 - $367 1462%
Multiplan $128 - $371 1485%
Prime Health Services $128 - $371 1485%
Galaxy Health Network $135 - $391 1566%
Three Rivers Provider Network $135 - $391 1566%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: Langhorne-Newtown Rd, Langhorne, PA 19047
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals