CMS Price Transparency Data

Culture, blood

Facility: Novant Health Forsyth Medical Center

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $64
Cash Discount Price: $64
vs. Medicare Baseline: 6.20x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Novant Health Forsyth Medical Center is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $64. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 6.20x the Medicare baseline. Located in 3333 Silas Creek Parkway, Winston-Salem, NC.

Cash / Self-Pay

$64

Average discount available for prompt cash payment at this facility.

Insurance Median

$64

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: $64 (620%)

Insurance Median: $64 (620%)

Cash: $64 (620% of Medicare)

Ins. Median: $64 (620% 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 620% of the Medicare baseline (a markup of 520%). 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
Amerihealth	$10 - $29	97%
Blue Cross Blue Shield	$10 - $111	97%
Carolina Complete	$10 - $29	97%
Humana	$10 - $120	97%
Nc Department Of Public Safety	$10 - $29	97%
Pace Of The Southern Piedmont	$10	97%
UnitedHealthcare	$10 - $104	97%
Wellcare	$10 - $29	97%
Aetna	$11 - $123	107%
Cigna	$11 - $91	107%
Liberty Health	$11	107%
Caresource North Carolina	$22 - $62	213%
Atlantic Corporation Dba Atlantic Packaging	$31 - $87	300%
Plotkin Health	$32 - $92	310%
Amps	$35 - $100	339%
Medcost	$46 - $145	446%
Primary Physician Care	$48 - $136	465%
Beechstreet	$49 - $139	475%
Multiplan	$49 - $139	475%
Phcs	$49 - $139	475%
Employers Choice Network	$52 - $149	504%
Three Rivers Provider Network	$52 - $149	504%

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 $64.
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 Novant Health Forsyth Medical Center 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.