CMS Price Transparency Data

Culture, blood

Facility: UPMC Chautauqua at Wca

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $19
Cash Discount Price: $25
vs. Medicare Baseline: 1.84x Medicare

The contracted insurance negotiated median rate for a Culture, blood at UPMC Chautauqua at Wca is $19. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 1.84x the Medicare baseline. Located in 207 Foote Avenue, Jamestown, NY.

Cash / Self-Pay

$25

Average discount available for prompt cash payment at this facility.

Insurance Median

$19

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: $25 (242%)

Insurance Median: $19 (184%)

Cash: $25 (242% of Medicare)

Ins. Median: $19 (184% 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.

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
Beacon	$10 - $13	97%
Fidelis	$10	97%
Geisinger	$10 - $19	97%
Humana	$10 - $34	97%
United Behavioral Health	$10	97%
UnitedHealthcare	$10 - $27	97%
Upmc Health Plan	$10 - $25	97%
Aetna	$11 - $27	107%
Independent Health	$11	107%
Univera	$11	107%
Wellcare	$11	107%
Health Partners Plans (Jefferson Health Plan)	$14	136%
Magnacare	$17 - $32	165%
Blue Cross Blue Shield	$26	252%
Multiplan	$32	310%
Ghi/Emblem Health	$34	329%
Statewide Independent Ppo	$37	359%
Affordable First Health	$38	368%

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 $25.
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 UPMC Chautauqua at Wca 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.