CMS Price Transparency Data

Culture, bacterial

Facility: UPMC Presbyterian Shadyside

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $75
Cash Discount Price: $438
vs. Medicare Baseline: 8.70x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at UPMC Presbyterian Shadyside is $75. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $438. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 8.70x the Medicare baseline. Located in 200 Lothrop Street, Pittsburgh, PA.

Cash / Self-Pay

$438

Average discount available for prompt cash payment at this facility.

Insurance Median

$75

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: $438 (5081%)

Insurance Median: $75 (870%)

Cash: $438 (5081% of Medicare)

Ins. Median: $75 (870% 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 870% of the Medicare baseline (a markup of 770%). 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
Health Partners Plans (Jefferson Health Plan)	$7	81%
UnitedHealthcare	$8 - $9	93%
Upmc Health Plan	$8 - $11	93%
Aetna	$9	104%
Amerihealth Caritas	$9 - $11	104%
Cigna	$9	104%
Highmark Wholecare (Prev Gateway)	$9 - $10	104%
Pa Health & Wellness	$9 - $12	104%
Upmc Work Partners	$9	104%
Multiplan	$10 - $584	116%
Geisinger	$11	128%
Blue Cross Blue Shield	$17 - $75	197%
Preferred Healthcare System	$474	5499%
Coventry/First Health	$511	5928%
Fidelis	$548	6357%
Intergroup	$548 - $620	6357%
Health Coalition Partners	$584	6775%
Private Health Care Systems	$584	6775%
Selectcare	$584	6775%
Health Payors Organization	$620	7193%
Humana	$620	7193%

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 $438.
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 Presbyterian Shadyside 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.