CMS Price Transparency Data

Culture, blood

Facility: Grant Regional Health Center

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $52
Cash Discount Price: $47
vs. Medicare Baseline: 5.04x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Grant Regional Health Center is $52. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $47. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 5.04x the Medicare baseline. Located in 507 S Monroe St, Lancaster, WI.

Cash / Self-Pay

$47

Average discount available for prompt cash payment at this facility.

Insurance Median

$52

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: $47 (455%)

Insurance Median: $52 (504%)

Cash: $47 (455% of Medicare)

Ins. Median: $52 (504% 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 504% of the Medicare baseline (a markup of 404%). 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
Dean Health Plan - All Plans	$7	68%
UnitedHealthcare	$7 - $64	68%
Americhoice Mcaid - All Plans	$12	116%
Quartz Mcr Adv	$32	310%
Medical Associates - All Plans	$52	504%
The Alliance - All Plans	$54	523%
Wps - All Plans	$58	562%
Blue Cross Blue Shield	$61	591%
Quartz Health Solution - All Other Plans	$134	1298%

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 $47.
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 Grant Regional Health 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.