CMS Price Transparency Data

Culture, bacterial

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 87070
  • Insurance Median: $126
  • Cash Discount Price: $69
  • vs. Medicare Baseline: 14.62x Medicare
The contracted insurance negotiated median rate for a Culture, bacterial at Carilion Stonewall Jackson Hospital is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $69. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 14.62x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.
Cash / Self-Pay
$69

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: $69 (800%)
Insurance Median: $126 (1462%)
Cash: $69 (800% 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
Blue Cross Blue Shield $9 104%
Sentara Health Plan $9 - $122 104%
Abh of Wva (Formerly Coventry) $9 104%
Humana $9 104%
UnitedHealthcare $9 - $161 104%
Abh of VA (Formerly Coventry) $9 104%
Aetna $100 - $131 1160%
Gateway - Tier 3 $108 1253%
Vhn - Ultra $122 1415%
Connecticare $138 1601%
Gateway - Tier 2 $158 1833%
Vhn - Plus $158 1833%
Cigna $158 1833%
Integrated Health Plan $167 1937%
Vhn $167 1937%
Vhn - Link $177 2053%
Beech Street $181 2100%
Vhn - Secondary Payors $187 2169%
Gateway - Tier 1 $187 2169%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1 Health Circle, Lexington, VA 24450
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals