CMS Price Transparency Data

Culture, blood

Facility: Gifford Medical Center

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $125
Cash Discount Price: $78
vs. Medicare Baseline: 12.11x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Gifford Medical Center is $125. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 12.11x the Medicare baseline. Located in 44 South Main Street, Randolph, VT.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$125

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: $78 (756%)

Insurance Median: $125 (1211%)

Cash: $78 (756% of Medicare)

Ins. Median: $125 (1211% 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 1211% of the Medicare baseline (a markup of 1111%). 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
UnitedHealthcare	$10 - $148	97%
Blue Cross Blue Shield	$51 - $133	494%
Martins Point Health Care	$70	678%
Mvp Health Care Of Ny	$70 - $133	678%
Cigna	$125	1211%
Harvard Pilgrim Health Care	$125	1211%
Multiplan	$145	1405%
Aetna	$148	1434%

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 $78.
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 Gifford 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.