CMS Price Transparency Data

Culture, blood

Facility: Carolina East Medical Center

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $86
Cash Discount Price: $91
vs. Medicare Baseline: 8.33x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Carolina East Medical Center is $86. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $91. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 8.33x the Medicare baseline. Located in 2000 Neuse Blvd, New Bern, NC.

Cash / Self-Pay

$91

Average discount available for prompt cash payment at this facility.

Insurance Median

$86

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: $91 (882%)

Insurance Median: $86 (833%)

Cash: $91 (882% of Medicare)

Ins. Median: $86 (833% 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 833% of the Medicare baseline (a markup of 733%). 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
Humana	$10	97%
Inclusive Health (Nchirp)-All Plans	$10	97%
Tricare	$10 - $206	97%
Craven Co. Jail Systems - All Plans	$25 - $69	242%
Pamlico Co Jail-All Plans	$26 - $55	252%
UnitedHealthcare	$34 - $146	329%
Medcost Ppo Employees And Retirees	$63 - $135	610%
Medcost Ppo Ultra (Employees)	$63 - $129	610%
Blue Cross Blue Shield	$67 - $141	649%
Medcost Ppo City Employees	$70 - $150	678%
Medcost Ppo County Employee	$73 - $156	707%
Benefit Mgmt, Svcs-All Plans	$82 - $175	795%
Aetna	$85 - $183	824%
Medcost Benefit Svc-All Other Plans	$85 - $182	824%
Acs Consult Svc Inc-All Plans	$87 - $186	843%
Cigna	$87 - $187	843%
Medcost Ppo Standard	$87 - $186	843%

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 $91.
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 Carolina East 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.