CMS Price Transparency Data

Culture, blood

Facility: UPMC Williamsport

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $288
Cash Discount Price: $400
vs. Medicare Baseline: 27.91x Medicare

The contracted insurance negotiated median rate for a Culture, blood at UPMC Williamsport is $288. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $400. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 27.91x the Medicare baseline. Located in 700 High Street, Williamsport, PA.

Cash / Self-Pay

$400

Average discount available for prompt cash payment at this facility.

Insurance Median

$288

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: $400 (3876%)

Insurance Median: $288 (2791%)

Cash: $400 (3876% of Medicare)

Ins. Median: $288 (2791% 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 2791% of the Medicare baseline (a markup of 2691%). 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
Blue Cross Blue Shield	$10 - $312	97%
Geisinger	$10 - $446	97%
Upmc Work Partners	$10	97%
Aetna	$11 - $440	107%
Amerihealth Caritas	$11 - $16	107%
Highmark Wholecare (Prev Gateway)	$11 - $20	107%
Multiplan	$11 - $519	107%
Pa Health & Wellness	$11 - $24	107%
Three Rivers Provider Network	$11 - $599	107%
UnitedHealthcare	$11 - $456	107%
Upmc Health Plan	$11 - $290	107%
Coventry/First Health	$252 - $448	2442%
Cigna	$342 - $456	3314%
Wirerope Works	$370	3585%
America'S Choice	$533	5165%
Intergroup	$533	5165%

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 $400.
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 Williamsport 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.