CMS Price Transparency Data

Culture, blood

Facility: UPMC Mercy

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $83
Cash Discount Price: $146
vs. Medicare Baseline: 8.04x Medicare

The contracted insurance negotiated median rate for a Culture, blood at UPMC Mercy is $83. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $146. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 8.04x the Medicare baseline. Located in 1400 Locust Street, Pittsburgh, PA.

Cash / Self-Pay

$146

Average discount available for prompt cash payment at this facility.

Insurance Median

$83

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: $146 (1415%)

Insurance Median: $83 (804%)

Cash: $146 (1415% of Medicare)

Ins. Median: $83 (804% 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 804% of the Medicare baseline (a markup of 704%). 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
Upmc Health Plan	$9 - $64	87%
Geisinger	$10	97%
Upmc Work Partners	$10	97%
Aetna	$11 - $98	107%
Amerihealth Caritas	$11 - $22	107%
Highmark Wholecare (Prev Gateway)	$11 - $21	107%
Pa Health & Wellness	$11 - $24	107%
UnitedHealthcare	$16	155%
Blue Cross Blue Shield	$20 - $64	194%
Cigna	$83 - $146	804%
Bravo	$85	824%
Coventry/First Health	$107	1037%
Intergroup	$122 - $195	1182%
Private Health Care Systems	$183	1773%
American Healthcare Group	$195	1890%
National Provider Network	$200	1938%
Health Payors Organization	$220	2132%
Multiplan	$220	2132%

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 $146.
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 Mercy 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.