CMS Price Transparency Data

Culture, blood

Facility: North Adams Regional Hospital Corporation

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $55
Cash Discount Price: $89
vs. Medicare Baseline: 5.33x Medicare

The contracted insurance negotiated median rate for a Culture, blood at North Adams Regional Hospital Corporation is $55. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $89. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 5.33x the Medicare baseline. Located in 71 Hospital Avenue, North Adams, MA.

Cash / Self-Pay

$89

Average discount available for prompt cash payment at this facility.

Insurance Median

$55

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: $89 (862%)

Insurance Median: $55 (533%)

Cash: $89 (862% of Medicare)

Ins. Median: $55 (533% 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 533% of the Medicare baseline (a markup of 433%). 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
Mcd Masshealth	$9	87%
Mcd New York	$9	87%
Mcd Out Of State	$9	87%
Mcdmanaged Bmchnp	$9 - $10	87%
Mcdmanaged Cdphp	$9	87%
Mcdmanaged Hne Mcdaco	$9	87%
Medicaid / KanCare	$9 - $41	87%
Comm Hospice	$10 - $22	97%
Mcdmanaged Network	$10 - $53	97%
Mcr Miscellaneous	$10 - $22	97%
Mcrmanaged Usa Family	$10 - $22	97%
Mcrmanaged Va	$10 - $22	97%
Medicare (plans)	$10 - $22	97%
Oth United Vaccn	$10 - $22	97%
Aetna	$12 - $71	116%
Blue Cross Blue Shield	$12 - $80	116%
Mcrmanaged Cca One Care	$12 - $21	116%
Tricare	$12 - $35	116%
Comm Fallon Qhp	$16 - $53	155%
Comm Unicare	$27 - $61	262%
Comm Network Qhpsub	$53 - $57	514%
Wc Workers Comp	$57	552%
Comm Network Qhpnonsub	$60 - $68	581%
Comm Nhp	$61	591%
Comm Hne Hmo	$62 - $71	601%
Comm Hne	$63 - $66	610%
Comm Hne Ppo	$66 - $71	640%
Comm Tufts	$74	717%
UnitedHealthcare	$81	785%
Cigna	$85 - $87	824%
Comm Cdphp	$85	824%
Comm Mvp	$85	824%
Comm Oxford	$85	824%
Comm First Health	$87 - $89	843%
Comm Connecticare	$89	862%
Comm Consolidated Health	$89	862%
Comm Harvard	$89	862%
Comm Other	$89	862%
Comm Phcs	$89	862%
Comm Self Pay	$89	862%

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 $89.
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 North Adams Regional Hospital Corporation 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.