CMS Price Transparency Data

Culture, blood

Facility: Lexington Memorial Hospital Inc

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $58
Cash Discount Price: $66
vs. Medicare Baseline: 5.62x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Lexington Memorial Hospital Inc is $58. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $66. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 5.62x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$66

Average discount available for prompt cash payment at this facility.

Insurance Median

$58

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: $66 (640%)

Insurance Median: $58 (562%)

Cash: $66 (640% of Medicare)

Ins. Median: $58 (562% 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 562% of the Medicare baseline (a markup of 462%). 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
Alliance	$19	184%
Amerihealth	$19 - $20	184%
Blue Cross Blue Shield	$19 - $31	184%
Carolina Complete	$19	184%
Healthy Blue	$19	184%
Partners	$19	184%
Trillium	$19	184%
UnitedHealthcare	$19 - $59	184%
Vaya	$19	184%
Wellcare	$19	184%
Ambetter / Centene	$20	194%
Medcost	$29 - $88	281%
Aetna	$37 - $122	359%
Oscar	$42 - $58	407%
Cigna	$57 - $58	552%
Directnet	$78	756%
Healthgram Lexington Home Brands	$95	921%
Healthgram	$106	1027%
Private Healthcare Systems	$108	1047%
Beechstreet	$116	1124%
Humana	$116	1124%
Multiplan	$119	1153%
National Provider Network	$119	1153%

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 $66.
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 Lexington Memorial Hospital Inc 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.