CMS Price Transparency Data

Culture, blood

Facility: North Carolina Baptist Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $43
Cash Discount Price: $64
vs. Medicare Baseline: 4.17x Medicare

The contracted insurance negotiated median rate for a Culture, blood at North Carolina Baptist Hospital is $43. 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 4.17x the Medicare baseline. Located in Medical Center Boulevard, Winston-Salem, NC.

Cash / Self-Pay

$64

Average discount available for prompt cash payment at this facility.

Insurance Median

$43

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: $43 (417%)

Cash: $64 (620% of Medicare)

Ins. Median: $43 (417% 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 417% of the Medicare baseline (a markup of 317%). 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	$10 - $111	97%
Apex	$10	97%
Blue Cross Blue Shield	$10 - $48	97%
Cigna	$10 - $79	97%
Devoted	$10	97%
Healthteam	$10	97%
Humana	$10 - $72	97%
Medicare (plans)	$10	97%
UnitedHealthcare	$10 - $45	97%
Wellcare	$10 - $19	97%
Liberty	$12	116%
Medcost	$18 - $87	174%
Alliance	$19	184%
Amerihealth	$19 - $31	184%
Carolina Complete	$19	184%
Health Blue	$19	184%
Partners	$19	184%
Trillium	$19	184%
Vaya	$19	184%
Ambetter / Centene	$28 - $30	271%
Oscar	$37 - $47	359%
Directnet	$73 - $77	707%
Cone Health	$87 - $92	843%
Healthgram	$87 - $92	843%
First Carolina Care	$99 - $105	959%
Private Healthcare Systems	$102 - $107	988%
Multiplan	$112 - $118	1085%

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 North Carolina Baptist 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.