CMS Price Transparency Data

Culture, blood

Facility: Carilion Tazewell Community Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $134
Cash Discount Price: $75
vs. Medicare Baseline: 12.98x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Carilion Tazewell Community Hospital is $134. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $75. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 12.98x the Medicare baseline. Located in 388 Ben Bolt Avenue, Tazewell, VA.

Cash / Self-Pay

$75

Average discount available for prompt cash payment at this facility.

Insurance Median

$134

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: $75 (727%)

Insurance Median: $134 (1298%)

Cash: $75 (727% of Medicare)

Ins. Median: $134 (1298% 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 1298% of the Medicare baseline (a markup of 1198%). 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
Corvel	$10	97%
Abh Of Va (Formerly Coventry)	$11	107%
Abh Of Wva (Formerly Coventry)	$11	107%
Blue Cross Blue Shield	$11	107%
Humana	$11	107%
Sentara Health Plan	$11 - $133	107%
UnitedHealthcare	$11 - $175	107%
Aetna	$109 - $142	1056%
Gateway - Tier 3	$118	1143%
Vhn - Ultra	$133	1289%
Cigna	$136 - $145	1318%
Connecticare	$150	1453%
Vhn - Plus	$165	1599%
Gateway - Tier 2	$171	1657%
Vhn	$171	1657%
Integrated Health Plan	$182	1764%
Vhn - Link	$193	1870%
Gateway - Tier 1	$203	1967%
Vhn - Secondary Payors	$203	1967%
National Provider Network	$205	1986%

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 $75.
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 Carilion Tazewell Community 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.