CMS Price Transparency Data

Culture, blood

Facility: Atrium Health Cleveland

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $136
Cash Discount Price: $150
vs. Medicare Baseline: 13.18x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Atrium Health Cleveland is $136. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $150. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 13.18x the Medicare baseline. Located in 201 E Grover St, Shelby, NC.

Cash / Self-Pay

$150

Average discount available for prompt cash payment at this facility.

Insurance Median

$136

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: $150 (1453%)

Insurance Median: $136 (1318%)

Cash: $150 (1453% of Medicare)

Ins. Median: $136 (1318% 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 1318% of the Medicare baseline (a markup of 1218%). 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
Aetna	$11 - $231	107%
Cigna	$11 - $240	107%
Humana	$11	107%
UnitedHealthcare	$11 - $160	107%
Alliance	$13 - $50	126%
Amerihealth Caritas	$13 - $42	126%
Carolina Complete Health	$13 - $43	126%
Healthy Blue	$13 - $43	126%
Partners	$13 - $42	126%
Trillium	$13 - $44	126%
Vaya	$13 - $44	126%
Wellcare	$13 - $43	126%
Blue Cross Blue Shield	$16 - $123	155%
Ambetter / Centene	$96 - $109	930%
Employers Health Network	$133 - $159	1289%
Physician Reach Out	$150	1453%
Medcost	$167 - $199	1618%
Magellan	$180	1744%
Gmmi	$195	1890%
Quik Trip	$195	1890%
Carolina Behavioral Health	$216 - $240	2093%
Healthgram	$240	2326%
Choicecare	$246	2384%
First Health	$255	2471%
Lifesynch Community Choice Care	$255	2471%
Private Health Care Systems	$270	2616%
Beechstreet	$276	2674%
Multiplan	$285	2762%

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 $150.
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 Atrium Health Cleveland 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.