CMS Price Transparency Data

Culture, blood

Facility: UPMC Horizon

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $72
Cash Discount Price: $113
vs. Medicare Baseline: 6.98x Medicare

The contracted insurance negotiated median rate for a Culture, blood at UPMC Horizon is $72. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $113. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 6.98x the Medicare baseline. Located in 110 North Main Street, Greenville, PA.

Cash / Self-Pay

$113

Average discount available for prompt cash payment at this facility.

Insurance Median

$72

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: $113 (1095%)

Insurance Median: $72 (698%)

Cash: $113 (1095% of Medicare)

Ins. Median: $72 (698% 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 698% of the Medicare baseline (a markup of 598%). 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%
Upmc Work Partners	$10	97%
Aetna	$11 - $113	107%
Amerihealth Caritas	$11 - $22	107%
Cigna	$11 - $75	107%
Highmark Wholecare (Prev Gateway)	$11 - $21	107%
Pa Health & Wellness	$11 - $24	107%
UnitedHealthcare	$11 - $75	107%
Health Partners Plans (Jefferson Health Plan)	$14	136%
Blue Cross Blue Shield	$19 - $86	184%
Geisinger	$19	184%
Intergroup	$122	1182%
Coventry/First Health	$124	1202%
Health Coalition Partners	$132	1279%
Private Health Care Systems	$150	1453%
Prime Net	$154	1492%
Humana	$160	1550%

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 $113.
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 Horizon 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.