CMS Price Transparency Data

Culture, bacterial

Facility: Margaretville Memorial Hospital

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $101
Cash Discount Price: $229
vs. Medicare Baseline: 11.72x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at Margaretville Memorial Hospital is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $229. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 11.72x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

$229

Average discount available for prompt cash payment at this facility.

Insurance Median

$101

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: $229 (2657%)

Insurance Median: $101 (1172%)

Cash: $229 (2657% of Medicare)

Ins. Median: $101 (1172% 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 1172% of the Medicare baseline (a markup of 1072%). 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
Oxford	$13	151%
UnitedHealthcare	$13 - $101	151%
Aetna	$23 - $229	267%
Mvp	$37	429%
Mvp Hmo/Ppo	$43	499%
Blue Cross Blue Shield	$51 - $101	592%
Self-Pay	$73	847%
Hamaspik (McR)	$101	1172%
Mvp Gold (McR)	$101	1172%
Medicare (plans)	$101 - $151	1172%
Affinity By Molina McR	$106	1230%
Cdphp	$111	1288%
Emblem Ghi/Hip Ppo/Cbp	$142	1647%
Mvp Exchange	$149	1729%
Emblem Select Care (Exchange)	$156	1810%
Magnacare Standard	$160	1856%
Oxford Exchange	$160	1856%
Todays Options	$166	1926%
Emblem Ghi/Hip Hmo/Epo/Pos	$183	2123%
Multiplan	$188	2181%
First Health	$206	2390%
Magnacare Preferred	$905	10499%

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 $229.
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 Margaretville Memorial Hospital 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.