CMS Price Transparency Data

Culture, bacterial

Facility: UPMC Bedford Memorial

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $59
Cash Discount Price: $67
vs. Medicare Baseline: 6.84x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at UPMC Bedford Memorial is $59. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $67. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 6.84x the Medicare baseline. Located in 10455 Lincoln Highway, Everett, PA.

Cash / Self-Pay

$67

Average discount available for prompt cash payment at this facility.

Insurance Median

$59

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$8.62

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $8.62 (100%)

Cash / Self-Pay: $67 (777%)

Insurance Median: $59 (684%)

Cash: $67 (777% of Medicare)

Ins. Median: $59 (684% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $8.62 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 684% of the Medicare baseline (a markup of 584%). 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
Aetna	$3 - $74	35%
Health Partners Plans (Jefferson Health Plan)	$7	81%
UnitedHealthcare	$7 - $74	81%
Upmc Health Plan	$7 - $39	81%
Amerihealth Caritas	$9 - $11	104%
Blue Cross Blue Shield	$9 - $57	104%
Cigna	$9 - $74	104%
Highmark Wholecare (Prev Gateway)	$9 - $10	104%
Pa Health & Wellness	$9 - $12	104%
Upmc Work Partners	$9	104%
Geisinger	$10	116%
Intergroup	$72 - $100	835%
Coventry/First Health	$78	905%
Preferred Healthcare System	$89	1032%
Health Coalition Partners	$100	1160%
Humana	$100	1160%
Private Health Care Systems	$100	1160%
Selectcare	$100	1160%

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 $67.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 87070.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UPMC Bedford Memorial is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 87070.
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.