CMS Price Transparency Data

Culture, blood

Facility: Piedmont Fayette Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $23
Cash Discount Price: $151
vs. Medicare Baseline: 2.23x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Piedmont Fayette Hospital is $23. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $151. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 2.23x the Medicare baseline. Located in 1255 Highway 54 West, Fayetteville, GA.

Cash / Self-Pay

$151

Average discount available for prompt cash payment at this facility.

Insurance Median

$23

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.32

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.32 (100%)

Cash / Self-Pay: $151 (1463%)

Insurance Median: $23 (223%)

Cash: $151 (1463% of Medicare)

Ins. Median: $23 (223% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.32 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 223% of the Medicare baseline (a markup of 123%). 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
UnitedHealthcare	$9	87%
Medicaid / KanCare	$11 - $15	107%
Blue Cross Blue Shield	$13	126%
Cigna	$16 - $23	155%
Alliant Health Plans Of Georgia [10952]	$37	359%
First Health [10303]	$352	3411%
Phcs [10601]	$352	3411%
Kaiser [10500]	$372	3605%
Novanet [10819]	$377	3653%
Beechstreet [10800]	$402	3895%
Multiplan [10600]	$427	4138%

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 $151.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 87040.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Piedmont Fayette Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 87040.
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.