CMS Price Transparency Data

Culture, blood

Facility: UPMC Presbyterian Shadyside

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $90
Cash Discount Price: $784
vs. Medicare Baseline: 8.72x Medicare

The contracted insurance negotiated median rate for a Culture, blood at UPMC Presbyterian Shadyside is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $784. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 8.72x the Medicare baseline. Located in 200 Lothrop Street, Pittsburgh, PA.

Cash / Self-Pay

$784

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $784 (7597%)

Insurance Median: $90 (872%)

Cash: $784 (7597% of Medicare)

Ins. Median: $90 (872% 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 872% of the Medicare baseline (a markup of 772%). 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 Work Partners	$10	97%
Aetna	$11 - $18	107%
Amerihealth Caritas	$11 - $22	107%
Cigna	$11	107%
Highmark Wholecare (Prev Gateway)	$11 - $21	107%
Pa Health & Wellness	$11 - $24	107%
UnitedHealthcare	$11 - $17	107%
Multiplan	$12 - $1,045	116%
Health Partners Plans (Jefferson Health Plan)	$14	136%
Upmc Health Plan	$15 - $19	145%
Blue Cross Blue Shield	$20 - $90	194%
Geisinger	$22	213%
Preferred Healthcare System	$849	8227%
Coventry/First Health	$914	8857%
Fidelis	$980	9496%
Intergroup	$980 - $1,110	9496%
Health Coalition Partners	$1,045	10126%
Private Health Care Systems	$1,045	10126%
Selectcare	$1,045	10126%
Health Payors Organization	$1,110	10756%
Humana	$1,110	10756%

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 $784.
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 Presbyterian Shadyside 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.